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Sex education

Attitudes of Mothers toward Sex Education

DORIS B L O C H , RN, D R P H

Abstract: Data are presented on the attitudes of
mothers from the entire social class spectrum toward
content and timing of sex education for children (CT-
Attitudes), and also toward sex education in school (S-
Attitudes) in two California communities in 1969.
Findings underscore the necessity to consider these
two attitudinal variables separately. As a result of their
separation for study purposes, it was possible to arrive
at a four-fold typology or grouping of mothers: 1) CT

liberals in favor, and 2) CT liberals opposed to sex
education in schools, 3) CT conservatives in favor,
and 4) CT conservatives opposed to school programs
of sex education. It is inferred that educational plan-
ners need to pay due regard to the sentiments of all
four maternal groups and all social classes in devel-
oping sex education programs for families and for
school children. (Am J Public Health 69:911-915
1979.)

There is need for a better understanding of parental atti-
tudes about sex education in school. Previous studies have
suffered from a lack of precision in defining “attitudes
toward sex education.” Attitude measurement has generally
mixed two different components which should not be inter-
meshed or mistaken one for the other. These components
are: 1) attitudes toward the content and timing of sex educa-
tion (CT-Attitudes), and 2) attitudes toward sex education in
school (S-Attitudes).

The data reported in this paper are derived from a larger
study whose purpose was to examine the dilemma which
may occur when there is a gap between what mothers feel
they should do and what they are actually doing in the sex
education of their children.’- ̂

Methodology

The Sample

The study here presented was carried out in two Califor-
nia locations, a small industrial city and a suburban “bed-
room” community. A random sample of 194 names was
drawn from the roster of all seventh-grade girls enrolled in

Address reprint requests to Doris Bloch, RN, DrPH, Chief, Re-
search Support Section, Division of Nursing, Bureau of Health
Manpower, Health Resources Administration, Department of
Health, Education, and Welfare, Center Bldg., Room 3-50, 3700
East-West Highway, Hyattsville, MD 20782. This paper, submitted
to the Joumal August 9, 1978, was revised and accepted for pub-
lication April 18, 1979.

the respective school districts. Interviews were requested
with the mothers of all 194 girls. As 4.6 per cent of the
mothers could not be located, 5.1 per cent had insufficient
comprehension of English to participate in a satisfactory in-
terview, and 17.5 per cent declined to participate in the
study, interviews were conducted with 141 mothers (72.7 per
cent) of the original sample. Of these 141 interviews, 17 con-
stituted the basis for a pilot study. Consequently, the data
here reported reflect interviews with 124 mothers, whose in-
dex daughters (all seventh graders) ranged in age from 11 to
14.*

The socioeconomic status of the study families was esti-
mated by use of the Hollingshead two-factor index of social
position^ (Table 1). Most of the mothers were currently mar-
ried (87.1 per cent) and almost all (95.2 per cent) were be-
tween ages 30 and 49.

Variables and their Measurement

CT-Attitudes: For this research a number of scales for
the measurement of sex education attitudes were exam-
ined.*”* However, none of these existing tools were found
entirely applicable to the present study because they mixed
S- and CT-Attitudes and because many items were unsatis-
factorily worded.

A provisional Likert scale consisting of 25 items was
therefore constructed to measure mothers’ attitudes toward
content and timing of sex education (CT-Attitudes). Some of
the component items were newly formulated, others were

*23.4 per cent age 11,71 percentage 12, 5.6 per cent over age
12; 65.3 per cent had not yet passed menarche.

AJPH September 1979, Vol. 69, No. 9 911

BLOCH

TABLE 1-Distribution of Respondents by Ethnic Group and TABLE 2 – M e a n CT Attitude Scores, by Sociai Class

Social Class

l & l l
III
IV
V

Total

S>0(

No,

44
17
21)
10
91

ciai u i a s s

White

Percent

48.4
18.7

22.0
11.0

100

No.

0
0

9
10
19

Black

Per Cent

.0

.0
47.4
52.6

100

Spanish

No. Percent

0 .0
1 7.1

5 35.7
8 57.1

14 100

No.

44
18

34
28

124

Total

Per Cent

35.5
14.5
27.4
22.8

100

Soclal Class

l & l l
III
IV
V

Total

aF = 6.51; d.f.

N

44
18
34
28

124

= 3, 120; p < .001.

Mean^

15.36
14.00
12.64
11.57
13.56

SD

2.82
4.05
3.83
4.89
4.07

taken from existing scales. Approximately one-half were
worded to denote a liberal opinion and the other one-half a
conservative opinion toward sex education. Subsequently,
this collection of items was revised to encompass the final
10-item scale (Appendix 1).**

The possible range of scores for this 10-item scale is
from 0 (most conservative) to 20 (most liberal). The actual
range for the study sample was 0 to 20, with a mean of 13.56
and a standard deviation of 4.07. Testing by split-half relia-
bility revealed a correlation of 0.54, corrected to 0.70 by the
Spearman Brown formula.'”

S-Attitudes: A 25-item scale for measuring attitudes
toward sex education in school was likewise constructed and
subsequently revised into a 10-item scale (Appendix 2).**
Possible range of scores for this scale is 0 (most unfavorable)
to 20 (most favorable). Actual range of scores for the study
sample was 0 to 20, with a mean of 13.42 and a standard
deviation of 4.71. Split-half reliability was 0.83, corrected to
0.91 by the Spearman-Brown formula.

The mothers were also asked to choose from a list of sex
information sources those which should be considered as
first, second, and third in importance. As limited evidence of
validity, it should be noted that the mothers who named the
school as the most preferred choice had the highest mean S-
Attitude score of any of the study participants; and those
who did not name the school as a desirable choice at all had
the lowest mean scores of the entire sample. When tested by
one-way analysis of variance, the difference between the
means was found to be statistically significant (F = 5.18;
d.f. = 3, 120; p < .005).

Findings

As indicated, the study data were analyzed in relation to
socioeconomic status. They reveal that 83.9 per cent of the
mothers gave either the mother or both parents as the pre-
ferred source of sex information for children. Some 93.5 per
cent of the socioeconomic class (SEC) I-III mothers named
parents as the preferred source of sex information, com-
pared to 79.4 per cent of those in SEC IV and 67.8 percent of
the SEC V participants. This finding indicates that the higher
their socioeconomic status, the more likely are mothers to

**Additional information about scale development is available
in references 1 and 9.

regard parents as the preferred source of sex education for
children (Chi-square = 10.10; d.f. = 2; p < .01).

Within SECs IV and V, no significant relationship was
found between ethnic group (white, Spanish-sumamed, or
black) and preferred information source, although a some-
what larger proportion of the white mothers named “par-
ents” as the preferred sex educator.

Attitudes toward Content and Timing of Sex Education
(CT-Attitudes)

On a possible scale of 0 to 20, with 0 representing the
most conservative position and 20 the most liberal, the mean
CT-Attitude score of the total participating group was 13.56,
with a standard deviation of 4.07. The data show a significant
relationship between social class and CT-Attitudes. The
higher the social class of the mothers, the more likely are
they to hold liberal CT-Attitudes (Table 2).

Attitudes toward Sex Education in School (S-Attitudes)

On a possible scale of 0 to 20, the mean S-Attitude score
of the 124 mothers was 13.41, with a standard deviation of
4.70. As was also the case with CT-Attitudes, analysis of
variance indicated a significant relationship between S-Atti-
tudes and socioeconomic class. However, a comparison of
Table 2 and Table 3, which follows, shows that the CT-and
S-Attitude responses present quite different patterns.

While the mean CT-Attitude scores follow a striaght-
line pattern for the socioeconomic groups, with mothers in
Classes I-II most liberal and those in Class V most con-
servative, the pattern of mean S-Attitude scores for these
respective class groups is less clear. In the case of S-Atti-
tudes, t-tests for equality of means indicate a statistically sig-
nificant difference between the S-Attitudes of Classes I, II,
and III mothers (combined) and Class IV and V mothers
(combined) (t, 2-tailed, = 4.28; d.f. = 122; p < .001), with
mothers in the two lower socioeconomic classes holding the
most favorable attitudes toward sex education in school, and
those in the upper three SEC classes holding the least favor-
able attitudes.

Relationship between CT-Attitudes and S-Attitudes

As anticipated, the data reveal a significant positive as-
sociation between the two sex education attitude variables:
the more liberal the attitudes toward the content and timing
of sex education, the more favorable are the attitudes toward

912 AJPH September 1979, Vol. 69, No. 9

ATTITUDES TOWARD SEX EDUCATION

TABLE 3—Mean S-Attltude Scores, by Social Class TABLE 4 – M e a n S-Attitude Scores, by Attitudes toward Con-

Social Class

l & l l
III
IV
V

Total

N

44
18
34
28

124

Meana

12,18
10,61
15,23
14,96
13,41

SD

5 34
4,57
3,48
3,62
4,70

leni ai

CT-Attitudes”

Conservative
Moderate
Liberal

Total

na liming or s

N

38
57
29

124

«x Education

Meana

11,73
13,43
15,58
13.41

SO

4,88
4,64
3.75
4.70

= 6.64; d.f. = 3, 120; p < .001 ^F = 5.94; d.f. = 2, 121; p < .005,
”Conservative: score 0 – 1 1 ; moderate: score 12-16; liberal: score 17-20.

sex educatioti in school (Table 4), Iti additioti, however, they
support the belief that the two attitude componetits are
largely independent of each other (Figure 1). It is evident
that the correlation between the CT- and S-Attitudes is far
from perfect, Pearson product-moment correlation between
them is ,28, only 7.8 per cent of the variance between the
two distributions being shared. It was possible, therefore, to
delineate four diflFerent types of mothers in terms of their
varying attitudes toward content-timing, and school sex edu-
cation: 1) mothers with high scores on both components (HI-
HIs, N = 40); 2) those with low scores on both components
(LO-LOs, N = 41); 3) CT-liberals with relatively unfavor-
able S-Attitudes (HI-LOs, N = l8);and4)CT-conservatives
with relatively favorable S-Attitudes (LO-HIs, N = 25),

In an effort to discover which factors distinguish these
four groups of mothers, the four groups were compared on a
number of variables. All 18 CT-liberals with unfavorable S-
Attitudes belonged to Classes I, II, and III, and almost all
CT-conservatives with favorable S-Attitudes belonged to
Classes IV and V, A sizable majority of mothers in all
groups—but less so in the LO-HI group—preferred the home

20
19
18
17
16
15
14
13
12
11

10
9
8
7
6
5
4
3
2
I

0

O

i
a: <
o o

o X
u ijj

I I I I I I I I I I I I I I I I I
I 2 3 4 5 6 7 8 9 10 II 12 13 14 15 16 17 18 19 20
SCORE FOR ATTITUDES TOWARO CONTENT AND

TIMING OF SEX EDUCATION

FIGURE 1—Scattergram of Attitudes toward the Content and Timing
of Sex Education and Attitudes toward Sex Education in School
(N=124)

as the source of sex information. The LO-LO mothers were
most likely to refuse permission for a daughter interview***
(Table 5),

Discussion

Maternal attitudes toward sex information for children
were analyzed with a focus on attitudes toward the source of
such information, and attitudes toward the content and tim-
ing of sex information. Content and timing were combined
into one tool, because these elements appeared too closely
allied to permit separation. Data were derived from inter-
views with 124 mothers of the seventh grade girls.

The analyses have included the variable “social class,”
since other significant variables, such as religion and
mother’s sex knowledge, are themselves highly correlated
with SEC class. Other variables, such as mother’s own sex
education, did not seem to relate to attitudes. Data on a num-
ber of daughter variables, such as birth order and whether or
not the daughter had passed menarche, were collected, but
were not analyzed in relation to maternal attitudes.

As expected, the overwhelming majority of the mothers
in the sample (84 per cent) took the traditional view that par-
ents should be primarily responsible for the sex education of
their children. Witmer* reported in 1929 that over 90 per cent
of mothers expressed the belief that children should receive
sex information in the home. Although the two studies are
not strictly comparable, there seems to have been little
change in 40 years,

CT-Attitudes were conceptualized as relevant to the pa-
rental role. They are regarded as that part of the role which
prescribes what and when children should be taught about
sex. Consistent with certain prior studies, this investigator
found a positive association between CT-Attitudes and so-
cial class. From the study data it may be concluded that the
higher the social class of mothers, the more likely they are to
feel that parents should be the primary (but not necessarily
the sole) sex educators, and that children should be taught
the facts of life at an early age and in extensive degree. Con-
versely, the lower their social class, the more likely are they
to feel that sources other than parents should assume the sex

***The daughter interview was requested to gain information
about the extent and sources of the girls’ sex knowledge. These data
will be reported elsewhere.

AJPH September 1979, Vol. 69, No. 9 913

BLOCH

TABLE 5-Distribution of Respondents by Attitude Typoiogy, and by Sociai Ciass, Preferred
Source of Sex Information, and Completion of Daughter interviews

Social Class®
mill
IVV

Home Preferred Source”
Yes
No

Daughter Interview”^
Completed
Refused

No.

20
20

35
5

34
6

HI-HI

Per Cent

50.0
50.0

87.5
22.5

85.0
15.0

CT Attitude—S-Attitude Typology

No.

18
0

18
0

15
3

HI-LO

Per Cent

100.0
.0

100.0
.0

83.3
16.7

No.

3
22

16
g

22
3

LO-HI

Per Cent

12.0
88.0

64.0
36.0

88.0
12.0

No.

21
20

35
6

21
20

LO-LO

Per Cent

51.2
48.8

85.4
24.6

51.2
48.8

No.

62
62

104
20

92
32

Total

Per Cent

50.0
50.0

83.9
16.1

74.2
25.8

a) x2 = 32.46; df. = 3; p < .001
b) x’ = 11.33; df. = 3;p < .025
c) x* = 17.02; df. = 3;p < .001

education function, and that relatively little should be re-
vealed to children, and that little relatively late.

S-Attitudes were also conceptualized as relevant to the
parental role. In contrast to CT-Attitudes, the data do not
indicate a linear, positive association between social class
and attitudes toward sex education in school. Mothers in the
lower social strata were most favorably inclined toward hav-
ing sex education a school responsibility.

Previous opinion studies, using various methodologies,
have consistently found parents to be highly favorable
toward sex education in school.””” However, the need to
separate CT and S sex education attitude components has
not been recognized in the past, so that the peculiar correla-
tion between social class and S-Attitudes has gone unno-
ticed. Sex education experts have generally labored under
the belief that support for sex education in schools is highest
in the higher social classes.*’ “• ‘*

Intuitively it would be expected that mothers with liber-
al attitudes toward the content and timing of sex education
would also be favorably inclined toward sex education in
school. However, a sizable proportion of the sample did not
fit the expected pattem.

If these findings can be generalized, professionals plan-
ning parent sex education groups, and those planning school
sex education programs for children should consider four,
rather than two types of parents. That is to say, they have to
take into account not just parents who are for and parents
who are against sex education, but four types of parents who
may react differently to the type of program that is proposed
and/or offered.

The HI-HI group may be most likely to take advantage
of parent education programs, but not need it as much as the
other parents. If they themselves are not doing a good job of
sex education with their children—despite the fact that they
want to—they are happy to have the school fill in the gaps.

The LO-LO group may not be very interested in parent
or school sex education, presumably feeling that sex and

sex education are better “swept under the rug.” However,
an attempt to involve these mothers in facing the issues
may possibly result in relatively high payoff in terms of liber-
alized CT-Attitudes as well as in liberalized S-Attitudes.

The HI-LO group may or may not take advantage of
parent education. Other data from the study (not reported
here) tend to support the belief that these mothers feel that
they are already doing a good job, although the validity of
their self-assessment can be questioned. Their CT-Attitudes
are already liberal; if they are not doing a good job of sex
education themselves, this may be due to deeper psychologi-
cal factors on which parent education may have little if any
efiFect. They are unlikely to favor school programs in any
case.

The LO-HI group may well feel too insecure about
doing the job of sex education themselves to be interested in
taking advantage of any parent education program that might
be ofiFered. It may be that they and their children are most
benefited by a good school sex education program.

Professionals planning new or improved school family
life and sex education programs for children must consider
these four types of parents; to think only in terms of parents
who favor and those who oppose sex education would be an
inadequate explanation of reality, and could result in mis-
understanding both those parents who favor and those who
are opposed to sex education in schools.

REFERENCES
1. Bloch D: Attitudes and practices of mothers in the sex educa-

tion of their daughters. Unpublished doctoral dissertation. Uni-
versity of California, Berkeley, 1970.

2. Bloch D: Sex education practices of mothers. Joumal of Sex
Education and Therapy 4:7-12, 1978.

3. Hollingshead AB; Two factor index of social position. New
Haven; Author, 1957.

4. Harris MH; Parent-teacher attitudes toward sex education and
the film. Human Growth. Unpublished master’s thesis. Univer-
sity of Oregon, 1949.

914 AJPH September 1979, Vol. 69, No. 9

ATTITUDES TOWARD SEX EDUCATION

5. Lemon B: Parental attitudes toward sex education. Unpub-
lished master’s thesis. University of Oregon, 1948.

6. Reeve SB: Parental attitudes toward sex education in junior
high school. Unpublished master’s thesis, Florida State Univer-
sity, 1963.

7. Shaw ME and Wright JM: Scales for the measurement of atti-
tudes. New York: McGraw Hill, 1967, pp. 63-64.

8. Witmer HL: The attitudes of mothers toward sex education.
N.p.: The University of Minnesota Press, 1929.

9. Ward MJ and Lindeman CA: Instruments for Measuring Nurs-
ing Practice and Other Health Care Variables: Psychosocial and
Physiological, Volume 1 and 2. DHEW Pub. No. HRA 78-53
and 78-54, Division of Nursing, Bureau of Health Manpower,
Health Resources Administration, Washington, DC, 1979.

10. Fox DJ: Fundamentals of research in nursing. New York: Ap-
pleton-Century-Crofts, 1966, pp. 231-232.

11. Paddack CT: Public opinion of the people of Washington regard-
ing the teaching of sex education in the public schools. Unpub-
lished master’s thesis. The State College of Washington, 1951,
pp. 14-15.

12. Fink K: Public thinks sex education courses should be taught in
the schools. Journal of Social Hygiene 37:62-63, 1951.

13. Field MD: Poll favors high school sex courses. San Francisco
Chronicle, p. 14, August 29, 1969.

14. Gallup G: Sex revolution in U.S., Part II. Princeton, NJ: Ameri-
can Institute of Public Opinion, June 23, 1969. (Report of Opin-
ion Poll).

15. Libby RW: Parental attitudes toward high school sex education
programs. The Family Coordinator 19:234-247, 1970.

16. Bowers RS: A study of opinions concerning the teaching of sex
education in the public schools. Unpublished master’s thesis.
East Tennessee State College, p. 58, 1962.

ACKNOWLEDGti/IENTS
This investigation was supported through fellowship No. NU-

27,049 from the National Institutes of Health, Division of Nursing;
also (in part) through General Research Support Grant SOl-FR-
05441 from the National Institutes of Health to the School of Public
Health, University of Califomia, Berkeley, and (in part) through a
Graduate Student Grant-in-Aid from the Graduate Division of the
University of California, in Berkeley.

The writer wishes to express appreciation to Dr. Susan Gort-
ner. Dr. Eugene Levine, and Mr. Roger Libby for reading and com-
menting upon a draft of this paper. Special thanks go to Mrs. Evelyn
Lazzari for her extensive assistance with the most difficult task, the
condensing of a lengthy manuscript. This paper reports on a portion
of the author’s doctoral dissertation, completed at the University
of California, Berkeley, in 1970.

APPENDIX 1 —Revised CT-Attitude Scale APPENDIX 2—Revised S-Attitude Scale

A U D Children should not be told about intercourse
0 1 2 until they are at least 12 years old.

A U D If a child of 6 asks where babies come from,
0 1 2 heshouldbe told: “From God; He lets a little

seed grow under mother’s heart.”

A U D Children should be taught that playing with
0 1 2 themselves is a bad habit.

A U D Children should be told that women have to
0 1 2 be married to have babies.

A U D Children should be allowed to see their pets
2 1 0 mate.

A U D Parents should teach their children not to talk
0 1 2 about the facts of life with other children.

A U D If a young child asks how the baby got inside
0 1 2 the mother, it’s best to change the subject.

A U D Children should only be told about the facts
0 I 2 of life when they ask questions.

A U D A child who wants to know how babies get
2 I 0 out of the mother, should be told the truth, no

matter how young he is.

A U D When a 5-year-old asks how babies get out of
0 1 2 the mother, he should be told he is too young

to know.

A U D Teaching the facts of life in school is as im-
2 1 0 portant as teaching reading, writing, and

arithmetic.

A U D Children should learn about the facts of life as
2 1 0 part of their regular work in school.

A U D When the facts of life are taught in school,
0 1 2 children are given too much information

when they are too young.

A U D When children are given a good sex educa-
2 1 0 tion in school, they will make wiser decisions

when they grow up.

A U D The facts of life should be taught in school, so
2 1 0 that children get the proper information.

A U D Schools should take the lead in teaching the
2 1 0 facts of life.

A U D Boys and girls should be together in classes
2 1 0 where the facts of life are taught.

A U D Teachers are too overworked to teach sex
0 1 2 education in addition to all their other duties.

A U D If the facts of life are taught in school, chil-
2 1 0 dren leam that sex is a normal part of life.

A U D Classroom discussion about sex will stimu-
0 1 2 late too much interest in raw sex.

AJPH September 1979, Vol. 69, No. 9 915

Sex education

48/SOCIETY • NOVEMBER / DECEMBER 1985

people as to the importance of enhancing contraceptive
etTorts. Many Swedish endeavors can be transformed for
use in American society, keeping in mind the cultural
differences. If such a transformation is to be made, there
is need for knowledge and insight in both cultures, and
that is a challenging task. Swedes cannot claim enough
insight about the American culture, with its many sub-
cultures, and Americans cannot claim enough insight
about the Swedish culture. A team effort seems
appropriate. D

Jan Trost is in the Department of Sociology at Uppsala Univer-
sity in Sweden. He has been a visiting scholar at the Kinsey In-
stitute and is the author of The Family in Change.

READINGS SUGGESTED BY THE AUTHOR:
Baldwin, Wendy H. “Adolescent Sexual and Reproductive

Behavior.” In Teen Parents and Their Children.
Washington, D.C: U.S. Government Printing OfTice,
1984.

Christensen, Harold T “Recent Data Reflecting upon the Sexual
Revolution in America.” In J. Trost, ed. The Eamily in
Change. Vasteras, Sweden: International Library, 1983.

Henshaw, Stanley K. and O’Reilly, Kevin. “Characteristics of
Abortion Patients in the United States, 1979 and 1980.”
Eamily Planning Perspectives 15 (1983).

Orr, Margaret Terry “Sex Education and Contraceptive
Education in U.S. Public High Schools.” Family Planning
Perspectives H {m2).

Rodman, Hyman; Lewis, Susan H. and GrifTith, Saralyn B. The
Sexual Rights of Adolescents. New York: Columbia
University Press, 1984.

Sex Education in High School

Madelon Lubin Finkel and Steven Finkel

T he offering of sex education in the public schools hasbeen the subject of often heated political and educa-
tional debate. What should be taught, by whom, and
when, are questions central to the controversy. Propo-
nents of sex education argue that such instruction
provides information that teens and preteens need to help
prevent some of the serious negative consequences of sex-
ual activity—that is, unwanted pregnancies and venereal
diseases. Opponents of such instruction argue that stu-
dents would be more likely to have sex after a course in
sex education. Research shows that those who have had a
course in sex education are no more likely to be sexually
active than those who have not, that females are less likely
to become pregnant and that they are more likely to use
contraceptives.

The rationale behind formal instruction in sex educa-
tion is that increased knowledge about human reproduc-
tion, sexual behavior, and contraception could dispel
misconceptions, myths, and half-truths while encourag-
ing more informed, responsible decision-making about
individual sexual activity and behavior; and it will help to
create satisfying interpersonal relationships. The popular

misconception, that the less teenagers know about sex the
less likely they are to experiment, has been shown repeat-
edly to be fallacious. Sexual intercourse does not cure
adolescents of ignorance regarding prevention of un-
wanted or unintended pregnancies, and ignorance does
not deter adolescents from sexual activity. Sex education
programs are not intended to override or to replace the
moral teaching of parents; rather, such instruction is de-
signed to provide the adolescent with additional facts and
knowledge of human sexual relationships. Many parents
shy away from discussing sex-related matters with their
children because either they are ignorant themselves or
feel uneasy or uncomfortable talking about such matters
with their offspring.

Most sex education courses include topics on human
reproduction, venereal diseases, pregnancy, and child-
birth; controversial issues such as abortion, con-
traception, and homosexuality often are avoided.
Although sex education is usually taught in the eighth and
eleventh grades, topics on family planning services are
not generally covered before high school. The actual
number of public school systems offering sex education is

CONTRACEPriON FOR TEENAGERS / 49

difficult to assess. A recent survey of high school prin-
cipals found that 36 percent of U.S. public high schools
offer a course in sex education and that no particular type
of school or community is most likely to offer a sex edu-
cation course. Not surprisingly, the topics covered, the
amount of time spent on each topic, and the quality of
teachers assigned to teach the course vary among the
schools; some schools offer a better program than others.

The need for a comprehensive course in human repro-
duction and human sexuality is best reflected by the sta-
tistics on teenage pregnancy, teenage abortions, and the
use of contraceptives among adolescents. Of the 29 mil-
lion teenagers between the ages of thirteen and nineteen,
12 million (41,1 percent) are estimated to have had sexual
intercourse. The proportion of those sexually experienced
rises sharply with increasing age, regardless of gender or

The number of abortions performed
on teenagers nearly doubled from 1973

to 1978.

ethnicity. More than one-fifth of first premarital pregnan-
cies among teenagers occurred within the first month
after initiating sex. Of the 1,1 million pregnancies that
occurred among teenagers in 1978, 77 percent were unin-
tended. The younger the teenager, the more likely that her
pregnancy was accidental or unintended. For many of the
young girls who find themselves pregnant, an abortion is
preferable to an unintended birth. Females aged fifteen to
nineteen terminated nearly two-fifths of their pregnancies
by abortion. The number of abortions obtained by teen-
agers nearly doubled from 1973 to 1978; during this time
period, nearly three out of every ten abortions were ob-
tained by teenage girls.

Although there is evidence to indicate that more teen-
agers are using effective methods of birth control now
than a decade ago, there is still a high degree of risk-
taking, particularly among those in the younger age
groups. Part of the problem is that inaccuracies, distor-
tions, and myths about human reproduction, pregnancy,
and contraception are widespread among teenagers of
both sexes. Forty-one percent of unmarried teenagers
polled in a nationwide study thought that they could not
become pregnant because they had mistakenly thought
“it was the wrong time of the month,” Of those who real-
ized that they could become pregnant, the most fre-
quently cited reason for not using a birth control method
was that they had not expected to have sex. Ignorance and
the unprotected, sporadic nature of teenage sexual en-
counters contribute to a high pregnancy rate among the

adolescent population, especially among teenagers fifteen
years old or younger.

Evidence shows that instruction in sex education can
increase knowledge of human reproduction. Public opin-
ion is solidly in support of the teaching of sex education
in schools: a recent public opinion poll found that 83
percent of those polled felt that sex education courses
should be taught in the schools. Support was especially
strong (over 90 percent) among certain demographic
groups; that is, the more educated, more affluent, Jewish
individuals.

The Family Living/Sex Education Curriculum was es-
tablished in 1967 in the New York City school system to
provide instruction for all pupils in kindergarten through
the twelfth grade. Among other things, this curriculum is
designed to help pupils understand the psychological and
physiological changes that are and will be taking place
within themselves and to focus on a wholesome attitude
toward sex and human sexuality as an important and
integrated part of one’s total being. Since the first publica-
tion of this curriculum, there have been rapid social
changes in society. As such, the New York City Board of
Education revised its curriculum in 1981-82, The revised
curriculum was implemented in the public schools in the
fall of 1982. An evaluation of the revised course provided
an excellent opportunity to assess how relevant the course
of instruction was and to see what the strengths and weak-
ness of the curriculum were.

The revised course focused not only on the factual as-
pects of human reproduction, but also on the socio-
psychological aspects of human sexuality. It was hoped
that there would be changes in students’ self-esteem, deci-
sion-making capabilities, interpersonal communication,
and sensitivity to others as a result of the course.

The purpose of this evaluation was to ascertain how
successfully the revised curriculum achieved its goals.
The study focused on the impact the new curriculum had
on students’ knowledge, attitudes, and behavior. Teacher
reaction to the course was also assessed. Since the curricu-
lum specifically delineated the concepts to be discussed in
class, the evaluation focused on these topics only:

• Males and females experience emotional, behavioral,
and physical changes during adolescence. The focus is
on factors influencing self-esteem, attitudes toward
one’s self and toward others, decision-making, and
communication of values,

• Sexual health requires responsibility. The focus is on
the biological aspects of human reproduction, sexually
transmitted diseases, personal hygiene, and forms of
sexual expression.

• Awareness of the reproductive process is conducive to
sound decision-making. The focus is on the role of ge-
netics in human reproduction, pregnancy, and
childbirth,

• Maintenance of a family involves responsibility. The
focus is on sex roles, marriage, parenting, and family
planning.

50/SOCIETY • NOVEMBER / DECEMBER 1985

The Board of Education, with funding from the March
of Dimes Foundation, conducted teacher training ses-
sions as a means of introducing the curriculum to those
teachers involved in the teaching of hygiene.

A random selection was made of four high schools in
the Bronx, New York. The high schools appeared to be
representative in terms of demographic and economic
characteristics of the public schools in that borough. All
eleventh-grade students attending public high school in
New York State are required to take a course in hygiene,
which includes a unit on sex education; therefore, stu-
dents enrolled in hygiene classes in the selected schools
comprised the study population. The evaluation was con-
ducted in the spring of 1983.

In the evaluation assessment, there was a need for com-
parisons in order to reach valid conclusions. A pretest/
posttest study design was utilized. A survey questionnaire
containing factual statements as well as scaled statements
revealing attitudes was administered both prior to and
several weeks after the unit on sex education was taught.
Each student who completed the pretest survey was as-
signed a unique identification number; the survey was
completed anonymously while the researchers main-
tained a code that permitted us to know the unique
number for each student so that comparisons of the pre-
test and the posttest scores could be made. This coded list
was not available to anyone else associated with the study.
The individual’s responses to the same statements were
compared to assess what changes, if any, resulted from the
course. Only those students who completed both the pre-
test and the posttest survey were included in this analysis.

Most of the statements have been used in other research
studies and have been tested and validated. To insure that
the questionnaires would be easily understood by senior
high school students, a pilot testing was conducted in
1982 under the auspices of the Board of Education. Nine
dimensions were included in the survey questionnaire:

• Responsibility: whether the student feels responsible
for his or her actions;

• Peer pressure: how much the student seems influenced
by or vulnerable to peer pressure;

• Attitudes toward self;
• Interpersonal attitudes: how much the student seems to

care for others;
• Gender roles: what the student feels is the proper be-

havior and social role for men and women;
• Personal hygiene knowledge;
• Knowledge of birth control;
• Knowledge of human reproduction;
• Knowledge of sexually transmitted diseases.

All knowledge statements were coded so that correct
answers were given scores of 1 and incorrect answers
scores of 2. In this way, the smaller the score on the knowl-
edge scales, the more knowledge exhibited on the given
dimension. The attitude statements were handled some-

what differently. For the responsibility scale, low scores
indicate a high degree of personal responsibility while
high scores indicate a perception that one is not responsi-
ble for one’s actions. Low scores on the peer pressure
index indicate a large amount of vulnerability to peer
pressure while low scores on the self and interpersonal
attitudes dimensions signify the most positive regard for
the self and others. The gender dimension was scaled so
that low scores indicate belief in traditional sex roles and
behavior (for example, “women’s place is in the home” or

Ignorance does not deter adolescents
from sexual activity.

“men should not show emotion”); a high score indicates
more modern values. Because of these difference in scale
construction, we would hope for increases on certain di-
mensions (such as peer pressure and gender) and de-
creases in the others if the course proved effective in
changing student attitudes and knowledge.

A total of 416 students who completed both the pretest
and the posttest were included in this anlysis, 82 percent
of the total eligible student population. The mean age of
the sample was 16.2 years with a range of 14 to 21 years.
Two-thirds of the students were female because one of the
schools had been an all female vocational high school and
is still overwhelmingly female. The students did apprecia-
bly better on the posttest knowledge scores than on the
pretest, A larger proportion of students scored better on
the true-false statements the second time around.
Whereas both the males and the females scored higher on
the posttest, the females scored higher than their male
counterparts. The students also did much better on the
posttest knowledge scores for the matching statements.

Students’ knowledge of human genetics increased from
the time of the pretest to the posttest. Nearly three-quar-
ters, 73.9 percent, knew that an infant may be born with a
birth defect if the pregnant female has rubella during the
first trimester. An additional 14 percent who initially an-
swered the statement incorrectly knew the correct answer
at the posttest. The majority, 53.7 percent, knew that each
normal human cell does not have forty-two chromosomes
at the time of the posttest. Forty-two percent knew for
both surveys that an X and Y chromosome will not de-
velop as a female, while an additional 23 percent knew
the correct answer at the posttest. The overwhelming ma-
jority, 84,6 percent, knew that sickle cell is a hereditary
condition; 89 percent of these knew the correct answer at
the pretest and at the posttest.

CONTRACEPTION FOR TEENAGERS / 51

The students did not do as well on the statements per-
taining to fertilization. The majority, 61.3 percent, did
not know where fertilization takes place and over half,
57.5 percent, did not know that a female’s menstrual cycle
determines when she can conceive. At the posttest, the
percentage of correct answers to these statements in-
creased by one-third and one-fifth, respectively. The ma-
jority of the students did not know when a female is at
greatest risk of becoming pregnant. Only 11.8 percent
knew both at the pretest and at the posttest that a female’s
time of greatest risk is not just before her monthly period
begins. Almost 71 percent of the students still did not
know the correct answer after taking the unit on sex edu-
cation. Whereas 35.1 percent knew at the pretest and at
the posttest that a female may become pregnant even if
the male withdraws his penis before ejaculating, an addi-
tional 40.4 percent knew the correct answer at the
posttest.

The majority knew that there are risks associated with
teenagers becoming pregnant. Specifically, the majority at
the posttest knew that prematurity and low birth weight
are associated with teenage pregnancy, and eight out of
ten knew that pregnant teenagers are at greater medical
risk because they often do not seek proper prenatal care.

The overwhelming majority knew that using a condom
will help prevent a person from getting a sexually trans-
mitted disease, and a similar percentage knew that there is
not a cure for genital herpes. More than eight out often
individuals knew that an important reason for the spread
of sexually transmitted diseases is the failure of people to
follow through with proper medical treatment. Of the 88
percent who knew the correct answer at the posttest, 81

Thirty-six percent of U.S. public high
schools offer a course in sex education.

percent knew the correct answer at both surveys. More
than half, 53.6 percent, at both the pretest and the posttest
knew that a male’s sperm are viable for up to three days
after ejaculation, and an additional 26.4 percent knew the
correct answer at the posttest.

Changes in individual attitude statements from the pre-
test to the posttest were subtle. That is, responsibility,
attitudes toward self, interpersonal attitudes, and gender
roles scales did not show major shifts in attitudes from the
pretest to the posttest. The responses to peer pressure
statements were comparatively more diverse, indicating
changing attitudes toward the importance and infiuence
of the peer group. For example, the mixture of responses
to the statement, “Teenagers are more likely to have sex if

their friends are having sex,” indicates a lack of consensus
among this sample. Almost as many agreed with the state-
ment as disagreed with it.

Statistical tests performed on the group average for
each dimension over time permit a more in-depth analy-
sis of the findings. The tests show whether there was a
significant difference on each dimension’s average score
before and after the course took place. In this analysis, the
observations are paired—the same individual is measured
before and after the course. Results of the comparison
indicate that on six of the nine dimensions there was a
significant change between the group averages over time.
Students came to feel more personally responsible for
their behavior; less traditional in their gender role orienta-
tions; and more knowledgeable about personal hygiene,
birth control, pregnancy, and sexually transmitted dis-
eases. On the three other dimensions—peer pressure, at-
titudes about one’s self, and attitudes toward others—the
differences went in the expected direction (that is, less
peer pressure, more favorable self and other orientations)
but failed to reach statistical significance. The most con-
clusive scores were registered on the knowledge dimen-
sions, especially regarding birth control, pregnancy, and
sexually transmitted diseases. Students retained the infor-
mation that was directly communicated in the course and
which, presumably, had direct practical implications and
applications to their own lives.

Further analysis was conducted to attempt to compare
the differences in the dimensions over time for men and
for women. Did men atid women increase their knowl-
edge or change their attitudes at an equal rate, or did one
sex dominate in the sex-oriented learning? There was, in
general, no significant difference between the sexes in the
amount learned or the amount of attitude change. For the
peer pressure scale, there was a greater movement away
from peer pressure among the men than among the
women; the latter group registered a very slight move-
ment toward more concern about their peers. Although
this attitude showed no general shift in the entire sample,
there appears to be a significant sex-related difference.
The findings also show that the females learned more
about pregnancy and sexually transmitted diseases than
did their male counterparts. The difference in the sex-
ually transmitted disease category is small and may not be
substantively meaningful.

Teachers React
The thirteen teachers generally felt that the new curric-

ulum worked well in terms of (1) helping the students
understand basic male and female reproduction, (2) be-
coming aware of contraceptive methods and their effec-
tiveness, (3) understanding sexually transmitted diseases,
(4) understanding the consequences of teenage pregnancy,
and (5) providing the opportunity to clarify attitudes and
feelings about sexuality. They felt that the curriculum was
comparatively less successful in (I) providing approaches
to aid in decision-making, (2) exploring similarities and

52/SOCIETY • NOVEMBER / DECEMBER 1985

differences in female and male roles, and (3) exploring the
problem of sexual abuse of children.

When asked which unit topics were most successful, the
majority of the teachers responded that the birth control
and family planning unit was the best. The teachers
thought that the curriculum’s major strength was its fac-
tual content. The only weakness in the curriculum was
expressed by one teacher: more time was needed to com-
plete the course. Eight of the thirteen teachers reported
that they have taken courses or attended workshops rele-
vant to human sexuality within the past two years. All but
one teacher said that they read books or journals about
issues in human sexuality. Several had masters degrees in
health education.

Myths about reproduction and
contraception are widespread among

teenagers of both sexes.

Evaluation of the revised sex education curriculum
clearly showed that the course was very successful in in-
creasing knowledge and somewhat successful in improv-
ing attitudes. Whether the course will be successful in
facilitating life-style changes (such as more consistent use
of effective contraceptives) was beyond the scope of this
evaluation and may be too much to expect from any
school-based educational program. While educators and
policymakers should be encouraged and pleased that a
course in sex edueation can successfully achieve its eduea-
tional objectives, knowledge alone is not enough to influ-
ence behavior. The revised curriculum provides the basis
for behavior changes by communicating information
over a relatively short period of time—one semester; it
alone cannot be expected to produce immediate, substan-
tive behavioral changes. Sueh changes need the support
and encouragement not only of the school system but also
of the peer group, the family, the community, and the
health profession.

Sex education courses can be powerful instruments for
instilling knowledge about sex-related subjects and for
changing sex role and gender orientations. On all of the
knowledge dimensions included in this evaluation.

change was observed after the course was completed.
Change was noted on two of the four attitudinal dimen-
sions measured as well. In addition, there were significant
gender differences on the scores for peer pressure and two
knowledge dimensions, knowledge of pregnancy and
knowledge of sexually transmitted diseases. Students at-
tended to information that they found relevant to their
own sexual lives and which could help them to make
more intelligent sex-related decisions and to be aware of
the risks of unwanted pregnancies. In these respects, the
course must be considered successful in influencing both
student knowledge and attitudes.

The results of this evaluation should be viewed with
encouragement by educators and policymakers; however,
by the time the course in family life, including sex educa-
tion, is taught, in the eleventh grade, many of the young
men and women have already engaged in sexual inter-
course. The high school curriculum should therefore be
more fully integrated into the junior high school family
life curriculum including sex education. Topics on inter-
personal relationships, the effects of peer pressure, self-
esteem, birth control, and human reproduction should be
included in the eighth-grade hygiene elass. By introducing
these topics in the junior high school, before sexual ac-
tivity commences, the concepts of responsible interper-
sonal and sexual relations could be introduced and
discussed. While the focus should be on educating stu-
dents about the basics of human reproduction and family
planning, class discussion could serve to allay fears, dispel
myths, and clear up confusion about sexual intercourse
among those who are not yet sexually experienced. Such
action could also lay the foundation for responsible inter-
personal and sexual behavior among this group. The
Board of Education should consider requiring all teachers
of hygiene either to hold a masters degree in health educa-
tion or to receive a certificate indicating that they are
trained to teach the course. Such action would insure that
the teachers have attained a specialized level of expertise
and are knowledgeable about the subject they are
teaching. D

Madelon Lubin Finkel is clinical assistant professor of public
health at Cornell University Medical College. She has written e.\-
tcnsively on the epidemiology of pregnancy among teenagers and is
a member of the American College of Epidemiology

Steven Finkel is assistant professor of political science at the
University of Virginia. He has also served as a biostatistical con-
sultant to many organizations.

Sex education

97 What do Parents in Mississippi Really Think About Sex Education in Schools? …

-McKee et al.

Journal of Health Disparities Research and Practice
Volume 7, Issue 1, Special Issue, Spring 2014, pp. 97 –
119
© 2011 Center for Health Disparities Research
School of Community Health Sciences
University of Nevada, Las Vegas

What Do Parents in Mississippi Really Think About Sex
Education in Schools? Results of a State-Level Survey

Colleen McKee, Mississippi State University
Kathleen Ragsdale, Mississippi State University
Linda H. Southward, Mississippi State University

ABSTRACT
Purpose: Despite broad public support for comprehensive sex education, its
implementation remains controversial in the United States, especially in states
such as Mississippi that have been identified as politically conservative. This
study examined parental opinions regarding the implementation of age-
appropriate sex-related education (SRE) (i.e., abstinence-plus education) in
Mississippi public schools.

Methods: Data were used from the first state-level survey of a randomized
sample of parents (N = 3,600) of public school students in Mississippi. The
sample was relatively equally distributed between non-Hispanic whites
(52.8%) and African Americans (48.2%). Bivariate and multivariate analyses
were conducted to determine parental support for a number of components
associated with comprehensive sex education (i.e., condom use
demonstration).

Results: More than 90% of parents endorsed implementing age-appropriate
SRE in Mississippi public schools, discussing the transmission and prevention
of HIV/STIs during SRE, and discussing how to get tested for HIV/STIs
during SRE. More than 80% endorsed discussing where to obtain birth control
during SRE and more than 70% endorsed demonstrating correct condom use
during SRE. Results varied somewhat across race/ethnicity and gender, such
that African American parents who were female were most supportive.

98 What do Parents in Mississippi Really Think About Sex Education in Schools? …

-McKee et al.

Conclusions: Although Mississippi has been identified as a politically
conservative state, our results indicate that an overwhelming majority of
surveyed parents endorsed age-appropriate SRE. Results may not be fully
generalizable to parents across the nation, yet they are consistent with similar
surveys conducted among parents in Minnesota, North Carolina, and Texas to
assess attitudes towards school-based sex education.

Keywords: Comprehensive sex education; Abstinence-plus education;
Abstinence-only education

99 What do Parents in Mississippi Really Think About Sex Education in Schools? …

-McKee et al.

INTRODUCTION
As of 2011, the teen birth rate in the United States was 31.3 per 1,000 for
girls 15-19 years old (CDC, 2013; Hamilton, Mathews & Ventura, 2013). As of
2008, the teen pregnancy rate in the United States was 68 per 1,000 for girls 15-
19 years old (NCPTUP, 2013a). Both rates are considerably higher in the United
States than in comparable developed nations (NCPTUP, 2012), as are rates of
sexually transmitted infections (STIs) among youth and young adults. As a case in
point, it is estimated that although 15-24 year olds represent only one-quarter of
ever-sexually active 15-44 year olds in the United States, they acquire nearly one-
half of all new STIs each year (Weinstock, Berman & Cates, 2004; CDC, 2012).
Other current statistics indicate that resource-limited states in the Southeast such
as Mississippi are severely affected by teen pregnancy, teen childbearing, and
STIs (NCPTUP, 2013a; Kost & Henshaw, 2013).

For example, Mississippi has the second highest teen birth rate (50.2) in
the nation (MSDH, 2011a). It also has the highest gonorrhea rate and the second
highest chlamydia rate in the nation (MSDH, 2011b). African American youth in
Mississippi are disproportionately at risk for teen pregnancy, teen childbearing,
and STIs as compared to white youth (MSDH, 2011a; MSDH, 2011b; NCPTUP,
2013b; Ragsdale & Sutton, 2012). For example, the teen pregnancy rate among
Mississippi’s African American youth is 70.6 per 1,000 as compared to 45 per
1,000 among white youth (MSDH, 2011a). Likewise, 75% of gonorrhea cases in
Mississippi are among African Americans (who comprise only 37.3% of the
population) and 69% are among 15-24 year olds (who comprise only 15% of the
population) (MSDH, 2011b; US Census, 2013).

According to the Centers for Disease Control and Prevention, “teen
pregnancy and childbearing bring substantial social and economic costs through
immediate and long-term impacts on teen parents and their children” (CDC, 2013
(The Importance of Prevention section, par 1). In Mississippi, the economic cost
of teen childbearing has been estimated to be about $154-$159 million annually
(NCPTUP, 2013b; MEPC, 2011). The social and public health costs of teen
childbearing include low birth weight infants, infant mortality, high school
dropout, chronic underemployment, and infants/children growing up in poverty
(Basch, 2011).

Although research suggests that comprehensive sex education targeting
youth is associated with reduced sexual risk behaviors, pregnancy, childbearing,
and STI acquisition (Cavazos-Rehg et al, 2012; Kohler, Manhart & Lafferty,
2008; Vivancos et al, 2013), state and federal support for abstinence-only sex
education (AOE) (which is also known as abstinence-only-until-marriage
education) is entrenched in the United States (Santelli et al, 2006).
According to Kohler and colleagues, comprehensive sex education programs
“include abstinence messages, but also provide information on birth control

100 What do Parents in Mississippi Really Think About Sex Education in Schools? …

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methods to prevent pregnancy and condoms to prevent STDs,” while AOE
programs advocate sexual abstinence until marriage and “discussion of birth
control methods is typically limited to statements about ineffectiveness” (2008, p.
345). State and federal support for AOE is a major concern given that—as the
landmark Waxman Report (2004) found—more than 80% of the federally funded
AOE programs scrutinized in the report contained “false, misleading, or distorted
information about reproductive health…presented as proven scientific facts”
(2004i; see also HRW, 2008). Another major concern is that even as the federal
government spends an estimated $170 million each year on AOE (SIECUS,
2013a), research suggests it is ineffective in reducing sexual risk behaviors among
youth (Basch, 2011; Santelli et al, 2006; Community Preventive Services Task
Force, 2013; Kirby, 2007; Mueller, Gavin & Kulkarni, 2008; SIECUS, 2009).
Although a number of studies indicate broad public support for
comprehensive sex education (Bleakley, Hennessy & Fishbein, 2006; Eisenberg
et al, 2008; Ito et al, 2006, Tortolero et al, 2011), its implementation remains
controversial in the United States (Kohler, Manhart & Lafferty, 2008; Goldman,
2011; Stanger-Hall & Hall, 2011). This is noteworthy in light of the fact that
many states—including states such as Mississippi that have been identified as
politically conservative (Gallup, 2012)—recognize the need for strategies to
reduce pregnancy, childbearing, and STIs among youth. In response to this need,
the Mississippi State Legislature passed House Bill 999 in 2011, which required
that all local school boards adopt a sex-related education policy by June 2012 and
that all public school districts implement AOE or abstinence-plus curricula for the
2012-2013 academic year (Mississippi State Legislature, 2011; SIECUS, 2013b).
While maintaining that AOE “shall remain the state standard for any sex-related
education taught in public schools” (Mississippi State Legislature, 2011, p. 2), the
bill also contains restrictions on sex education curricula content—such as
prohibiting condom use demonstration. In this paper, we examine results of a
state-level survey to assess parental opinions regarding school-based sex
education and discuss policy implications for implementing sex-related education.

METHODS
In response to House Bill 999, the Social Science Research Center (SSRC) of
Mississippi State University was commissioned by the Center for Mississippi
Health Policy to conduct the first state-level telephone survey of parents (N =
3,600) of public school students in 2011. The survey assessed parental opinions
regarding the implementation of sex-related education in Mississippi public
schools (McKee et al, 2011).

Using a computer-assisted telephone interview program, data were
collected from September through October 2011 by trained interviewers at the
SSRC Wolfgang Frese Survey Research Laboratory. The sample was randomly

101 What do Parents in Mississippi Really Think About Sex Education in Schools? …

-McKee et al.

selected from a telephone database from the Mississippi Department of Education
of all parents in Mississippi with a child enrolled in public school. From this
database of 491,540 phone numbers, the SSRC obtained 50,000 phone numbers
from which we drew a final randomized sample of 3,600 participants. Eight call
attempts were made before a phone number was assigned a final disposition. The
sampling error for the total dataset (binomial response option with 50/50 split)
was no larger than ± 3.5% with a 95% confidence interval. A finite population
correction formula was applied prior to calculating the margin of error.
Respondents were not compensated for participation in the 10-minute survey,
which had a response rate of 55.2%. All study procedures were approved by the
Mississippi State University Institutional Review Board.

Measures
The 36-item survey collected information on parents’ sociodemographics and
opinions regarding implementing sex-related education in Mississippi public
schools. For the survey, we drew on House Bill 999 to define sex-related
education as abstinence-plus education that includes AOE as defined by the Bill,
as well as “information about contraceptives and barrier methods as a means to
reduce the risk of pregnancy, sexually transmitted infections and diseases”
(McKee et al, 2011). Participants were specifically advised that abstinence-plus
education was referred to as sex-related education (SRE).

Sociodemographic characteristics
Participants were asked to identify the racial/ethnic group(s) that best described
them. Therefore, the small subsample racial/ethnic minorities other than African
American who completed the survey (2.5%) were excluded from the final
analyses. Race/ethnicity was coded as 0 = white and 1 = African American.
Gender was coded as 0 = female and 1 = male. Age was a continuous variable.
Education was recoded as 0 ≤ four years of high school, 1 = 1-3 years of college,
2 = college graduate, and 3 ≥ 1 year of graduate school. Marital status was
recoded as 0 = non-married (i.e., single, cohabiting, separated, divorced,
widowed) and 1 = married. Income was recoded as 0 ≤ $20,000, 1 = $20,000-
49,999, 2 = $50,000-74,999, and 3 ≥ $75,000. Participants were asked how many
school-aged children (i.e., kindergarteners through twelfth graders) resided in
their households and the grade and gender of each child. Participants were also
asked whether they had voted in the last major local or national election as of
October 2011.

Parental opinions regarding age-appropriate SRE
“Yes/no,” multiple choice, and Likert-type items were used to assess parental
attitudes towards age-appropriate SRE in Mississippi public schools. “Yes/no”
items included, “In your opinion, should sex-related education be taught in the

102 What do Parents in Mississippi Really Think About Sex Education in Schools? …

-McKee et al.

Mississippi public school system at an age-appropriate grade level?” Multiple
choice items included, “In your opinion, how should student participation in sex-
related education be determined” and response categories included (1) parents
should have to sign a form for their child to participate (i.e., active parental
consent), (2) children should be automatically enrolled unless the parent provides
a written request not to participate (i.e., passive parental consent), (3) don’t
know/not sure, and (4) refused.

Analysis Plan
For the 5-point Likert-type items, parents were asked to indicate their support for
15 items sometimes taught in SRE, such as “How to use a condom correctly
through classroom demonstrations.” Item responses ranged from “strongly
support” to “strongly oppose” and included “no opinion” as the midpoint. Each
item was recoded into three categories, where 1 = support, 2 = no opinion, and 3 =
oppose. The 7-point Likert-type item was as follows: “On a scale of 1 to 5 with 1
being least important and 5 being most important, who do you think should
determine the material taught in sex-related education class?” with the following
response categories: (1) parents, (2) students, (3) school health councils, (4)
principals and teachers, (5) school boards, (6) public health professionals, (7)
religious leaders, (8) politicians, and (9) other. Each response category was
recoded such that 1 = most important, 2 = neutral, and 3 = least important.

We conducted descriptive analyses (i.e., frequencies, cross tabulations,
and correlations) to examine our variables of interest. Pearson correlations were
used to determine the strength of an association between variables. We used
binominal logistic regression to predict parental attitudes towards age-appropriate
SRE using the following coefficients: race/ethnicity (reference category, white),
gender (reference category, female), age, education (reference category, ≤ high
school degree) and income (reference category, < $20,000). We examined the
overall model, individual predictors, and the odds ratio (OR) to determine how
each coefficient affected the outcome, using a 95% confidence interval (CI). For
the logistic regression models 1-6, all responses of “don’t know/not sure” and
“refused” were excluded from the final analyses. Analyses were conducting using
SPSS 21.0 and significance level was set at p < .05.

RESULTS
As Table 1 indicates, the sample (N = 3,600) was relatively equally distributed
between non-Hispanic whites (52.8%) and African Americans (48.2%), and was
relatively representative of Mississippi’s adult population of whites and African
Americans (57.7% and 37.3%, respectively) (US Census Bureau, 2013).

The majority of participants were African American females (85.6%),
followed by white females (78.9%), white males (21.1%), and African American

103 What do Parents in Mississippi Really Think About Sex Education in Schools? …

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males (14.4%). The mean age of participants was 40.4 years (standard deviation
9.9), of whom 60.9% were married. The age range of respondents’ oldest child
was relatively equally distributed, such that 36.1% of respondents’ oldest children
were in high school, 31% were in middle school, and 32.9% were in elementary
school. The majority of participants had voted in the last major local or national
election as of October 2011. Finally, 88.5% of parents ranked public health
officials as most important in terms of determining SRE content, followed closely
by school health officials (83.5%), parents themselves (74.6%), and principals and
teachers (74%). Parents ranked school boards (59.5%), religious leaders (52.5%),
and students (45.6%) similarly in terms of importance in determining SRE
content, while politicians were ranked a distant last (21.5%).
As Table 2 indicates, 92.1% of parents endorsed implementing age-
appropriate SRE in Mississippi public schools. Among the minority of parents
who did not endorse this item, 4.9% believed that parents should be the ones to
teach their children about sexuality, 0.4% believed it is inappropriate to teach
adolescents about sex (0.4%), and 0.2% believed that SRE will encourage
adolescents to engage in sexual activity. African American males and white males
were significantly less likely to endorse this item (p < .05 and < .001,
respectively). In addition, white males were significantly more likely than other
parents to select the “not sure” response item (p < .001). Nearly 96% of parents
endorsed SRE that instructs students on how to talk with parents about sex and
relationship issues. White males were significantly less likely to endorse this item
(p < .05). Nearly 95% of parents endorsed SRE that includes discussing
transmission and prevention of HIV/STIs. White males were significantly less
likely to endorse this item (p < .001). More than 91% of parents endorsed SRE
that includes discussing how to get tested for HIV/STIs. White males were
significantly less likely to endorse this item (p < .001). Nearly 83% of parents
endorsed SRE that instructs students on how to talk with a girlfriend/boyfriend
about birth control. Regardless of gender, white parents were significantly less
likely to endorse this item (p < .001 for both groups).

More than 90% of parents endorsed instruction on birth control methods
during SRE classes. Again, regardless of gender, white parents were significantly
less likely to endorse this item (p < .001 for both groups). Eighty-two percent of
parents endorsed instruction on where to obtain birth control products. African
American males and white parents of both genders were significantly less likely
to endorse this item (p < .001 for all three groups). More than 72% of parents
endorsed demonstrations of correct condom use during SRE. As Table 2
indicates, white males were less likely to endorse this item (p < .001). Nearly 61%
of parents endorsed gender-segregated SRE classes. Regardless of gender, white
parents were significantly more likely to endorse this item (p < .05 for both
groups). Nearly 55% of parents endorsed active parental consent for children to

104 What do Parents in Mississippi Really Think About Sex Education in Schools? …

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participate in SRE (i.e., parent should have to sign a form for the child to receive
SRE). White males were more likely to endorse active parental consent (p < .001).
Finally, parents ranked public health officials as most important in terms
of determining the content of SRE, followed closely by school health officials
(83.5%), parents themselves (74.6%), and principals and teachers (74%). Parents
ranked school boards (59.5%), religious leaders (52.5%), and students (45.6%)
similarly in terms of importance in determining the content of SRE, while
politicians were ranked a distant last (21.5%).

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Table 1. Sociodemographic characteristics of study sample (N = 3,600)

Socioeconomic Demographics
Should Sex-related Education be Taught in the
Public School System?

Participants Frequency %
Yes No Not Sure

Significance

Sex p < .001

Female 2,950 81.9 93.5 4.9 1.6

Male 650 18.1 85.8 9.8 4.3

Race/Ethnicity p < .001

White 1,800 51.8 87.7 9.4 3.5

African American 1,675 48.2 97.6 1.9 0.5

Income Level p < .001

Below 20,000 901 29.9 95.7 3.2 1.1

20,000 to 49,999 1,108 36.7 93.6 4.7 1.7

50,000 to 74,999 449 14.9 87.8 9.6 2.7

Above 75,000 560 18.6 89.8 6.8 3.4

Education Level p = .05

≥ High School education 1,389 38.7 93.4 4.8 3.8

1-3 years of College 1,095 30.5 91.4 6.2 2.4

College Graduate 691 19.3 92.2 5.2 2.6

≥ 1 year graduate school 411 11.5 89.3 9.2 1.5

Age (Years)

18 to 29 377 10.5 95.2 4.2 0.5

30 to 34 718 19.9 94.4 4.2 1.4

35 to 39 742 20.6 92.7 5.1 2.2

40 to 44 673 18.7 90.6 6.7 2.7

45 to 54 763 21.2 89.5 7.3 3.1

55 and Older 327 9.1 90.8 7.3 1.8

Voted Last Major Electiona

Yes 2,974 82.8 93.3 5.0 1.7 p < .001

No 619 17.2 85.1 10.8 4.1

Marital Status

Married 2,193 61.1 89.8 7.4 2.7 p < .001

Cohabiting 77 2.1 94.8 2.6 2.6

Single 654 18.2 97.2 2.1 0.6

Separated, Divorced
or Widowed 664 18.5 94.3 4.2 1.5

Totalb 3,600 100 92.1 5.8 2.1

* p < .05. ** p < .01. *** p < .001.

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a Voted in last major election as of October 2011.
b Totals may not equal 100% due to rounding.

Table 2. Items that were significant by race/ethnicity and by gender.

Should age-appropriate sex-related education be taught in Mississippi public schools?

N Yes %
No
%

No
Opinion

%
*Significance

African
American 1,675 p< .05

Female 1,434 97.9 1.6 0.5
Male 241 95.4 3.7 1.08
White 1,800 p < .001
Female 1,420 89.2 8.1 2.7
Male 380 79.2 14.2 6.6*
Do you support teaching students how to talk to parents about sex and relationship
issues during age-appropriate sex-related education?

N Yes %
No
%

No
Opinion

%
*Significance

African
American 1,673

Female 1,433 98.2 1.1 0.7
Male 240 97.1 2.5 0.4
White 1,795 p < .05
Female 1,415 94.4 4.2 1.4
Male 380 90.5 7.9 1.6
Do you discussion on how to talk with boyfriend/girlfriend about birth control?

N Yes %
No
%

No
Opinion

%
*Significance

African
American 1,670

Female 1,431 89.0 8.4 2.6
Male 239 86.6 10.0 3.3
White 1,779 p < .001
Female 1,404 80.4 15.3 4.3
Male 375 66.9 28.5 4.5

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Do you support teaching about birth control methods during age-appropriate sex-related
education?

N
Yes No No Opinion *Significance
% % %

African
American

1,671

Female 1,431 94.7 3.9 1.4
Male 240 90.8 6.7 2.5
White 1,788 p < .001
Female 1,411 88.6 8.6* 2.8
Male 377 79.6 17.5* 2.9
Do you support teaching where to obtain birth control products during age-appropriate
sex-related education?

N
Yes No No Opinion *Significance
% % %

African
American

1,670 p = .001

Female 1,430 89.2 7.8 3.0
Male 240 80.8 12.5 6.7
White 1,781 p < .001
Female 1,407 79.4 16.7 3.9
Male 374 65.5 30.2 4.3
Should correct condom use be demonstrated during age-appropriate sex-related
education?

N
Yes No No Opinion *Significance
% % %

African
American 1,660 p < .01

Female 1,425 83.0 13.1 3.9
Male 235 74.9 20.0 5.1
White 1,764 p < .001
Female 1,390 65.5 28.2 6.3
Male 374 52.7 40.6 6.7

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Should classes be gender-segregated during age-appropriate sex-related education?

N
Yes No No Opinion *Significance
% % %

African American 1,675
Female 1,434 45.9 49.1 5.0
Male 241 48.5 46.1 5.4
White 1,800 p < .05
Female 1,420 76.0 17.6 6.4
Male 380 71.6 23.7 4.7
How should student participation in age-appropriate sex-related education be
determined?

N

Active
Parental

Passive
Parental Not Sure/

*Significance Consenta Consentb Refused
% % %
African American 1,675
Female 1,434 52.1 46.7 1.3
Male 241 55.2 42.7 2.1
White 1,800 p < .001
Female 1,420 54.7 43.8 1.5
Male 380 65.0 34.5 0.06
* p < .05. ** p < .01. *** p < .001.

a Parent should have to sign a form for child to participate in SRE.
b Child should be automatically enrolled in SRE unless parent provides written request

that child not participate.

Binomial Regression Predicting Parental Support for Age-Appropriate SRE

In order to predict parental support for SRE, we devised six logistic regression
models using five dependent variables (race/ethnicity, gender, age, education, and
income). All five variables were significant predictors of parental support for
SRE. Race/ethnicity was significant at p < .001 in models 1, 4 and 5 and
significant at p < .01 in model 2. Gender was significant at p < .001 in models 1, 4
and 5 and significant at p < .01 in models 2 and 3. Age was significant at p < .001
in models 4 and 5 and significant at p < .05 in model 3. Education was significant
at p < .001 in model 6, significant at p < .01 in model 5, and significant at p < .05
in model 6. Income was significant at p < .001 in models 3 through 6, significant

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at p < .01 in models 4 and 5, and significant at p < .05 in model 1, 4 and 6. These
results are discussed in detail below and included in Tables 3 and 4.

In model 1, we explored which dependent variables predicted parental
support for implementing SRE in Mississippi. Among the 3,524 participants who
responded to the question, “Should sex-related education be taught in Mississippi
schools?,” 94.1% responded “yes” (n = 3,315). As compared to white parents,
African American parents were more likely to support SRE implementation in
Mississippi (OR = 5.20, 95% CI = 3.29-8.22, p < .001). As compared to female
parents, male parents were less likely to support SRE (OR = .46, 95% CI = .32-
.66, p < .001). As compared to parents with incomes below $20,000, those with
incomes of $50,000-74,999 were less likely to support SRE (OR = .68, 95% CI =
.51-.91, p < .05).

In model 2, we explored which dependent variables predicted parental
support for discussing the transmission and prevention of HIV/STIs during SRE.
Among the 3,498 participants who responded to the question, “Do you support
teaching about the transmission and prevention of HIV/STIs?” 94.9% responded
“yes” (n = 3,321). As compared to white parents, African American parents were
more likely to support this item (OR = 1.81, 95% CI = 1.24-2.64, p < .01). As
compared to female parents, male parents were less likely to support this item
(OR = .55, 95% CI = .37-.80, p < .01).

In model 3, we explored which dependent variables predicted parental
support for discussing how to get tested for HIV/STIs during SRE. Among the
3,511 participants who responded to the question, “Do you support teaching about
getting tested for HIV/STIs?,” 93.2% responded “yes” (n =3,273). As compared
to white parents, African American parents were more likely to support this item
(OR = 2.80, 95% CI = 1.92-4.11, p < .001). As compared to female parents, male
parents were less likely to support this item (OR = .62, 95% CI = .44-.87, p <
.01). As compared to younger parents, older parents were less likely to support
this item (OR = .98, 95% CI = .96-1.0, p < .05). As compared to parents with
incomes below $20,000, those with incomes of $50,000-74,999 were less likely to
support this item (OR = .38, 95% CI = .22-.66, p < .001) as were those with
incomes of ≥ $75,000 (OR = .34, 95% CI = .20-.59, p < .001).

In model 4, we explored which dependent variables predicted parental
support for discussing where to obtain birth control during SRE. Among the 3,440
participants who responded to the question, “Do you support teaching about
where to obtain birth control products?,” 85.3% responded “yes” (n = 2,933). As
compared to white parents, African American parents were more likely to support
this item (OR = 1.99, 95% CI = 1.56-2.54, p < .001).
As compared to female parents, male parents were less likely to support this item
(OR = .55, 95% CI = .43-.70, p < .001). As compared to younger parents, older

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parents were less likely to support this item (OR = .98, 95% CI = .97-.99, p <
.001).
As compared to parents with incomes below $20,000, those with incomes of
$20,000-49,999 were less likely to support this item (OR = .70, 95% CI = .51-.96,
p < .05), as were those with incomes of $50,000-74,999 (OR = .56, 95% CI = .38-
.82, p < .01) and those with incomes of ≥ $75,000 (OR = .43, 95% CI = .30-.63, p
< .001).

In model 5, we explored which dependent variables predicted parental
support for demonstrating correct condom use during SRE. Among the 3,361
participants who responded to the question, “Do you support teaching correct
condom use demonstrations?” 76.2% responded “yes” (n = 2,560). As compared
to white parents, African American parents were more likely to support the item
(OR = 2.14, 95% CI = 1.97-2.96, p < .001). As compared to female parents, male
parents were less likely to support the item (OR = .64, 95% CI = .51-.81, p <
.001). As compared to younger parents, older parents were less likely to support
the item (OR = .98, 95% CI = .97-.99, p < .001). As compared to parents with ≤
high school education, those who had ≥ 1 year of graduate school were less likely
to support the item (OR = .61, 95% CI = .44-.83, p < .01). As compared to parents
with incomes below $20,000, those with incomes of $50,000-74,999 were less
likely to support this item (OR = .62, 95%, CI = .45-.85, p < .01) as were those
with incomes of ≥ $75,000 (OR = .55, 95% CI = .40-.75, p < .001).

In model 6, we explored which dependent variables predicted parental
support for segregating students by gender during SRE. Among the 3,399
participants who responded to the question, “Should classes be gender-segregated
during sex-related education?,” 64.5% responded “yes” (n = 2,194). As compared
to white parents, African American parents were less likely to support this item
(OR = 2.863, 95% CI = .22-.32, p < .001). As compared to parents with ≤ high
school education, those who had 1-3 years of college were more likely to support
this item (OR = 1.53, 95% CI = 1.25-1.89, p < .001), as were those who were
college graduates (OR = 1.29, 95% CI = 1.0-1.66, p < .05) and those with ≥ 1 year
of graduate school (OR =1.87, 95% CI =1.37-2.56, p < .001). As compared to
parents with incomes below $20,000, those with incomes of $20,000-49,999 were
more likely to support this item (OR = 1.26, 95% CI = 1.03-1.55, p < .05), as
were those with incomes of $50,000-74,999 (OR = 1.47, 95% CI = 1.10-1.97, p <
.05), and those with incomes of ≥ $75,000 (OR = 1.83, 95% CI = 1.35-2.48, p <
.001).

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Table 3. Binomial Regression Predicting Parental Support for Sex-Related Education in Mississippi
Public Schools

At an age-appropriate grade level, in your opinion should:
Model 1 Model 2 Model 3

Sex-related education be tau

Sex education

Is Marijuana Use Safe?

Modeled example for the Week 3 assignment

John Smith

University of Arizona Global Campus

PHI103 Informal Logic

Dr. Christopher Foster

Due: Day 7 of Week 3

Begin with a title page,

formatted according to

APA standards.

With many states legalizing both medical and recreational marijuana, an important

question for voters, legislators, and potential users is whether marijuana is safe. There have been

many studies done on the topic, with findings on both sides. The focus of this paper will be to

present scholarly research on both sides of the question and to evaluate the quality of each. To

provide the most reliable information possible, I have chosen to present the findings of meta-

studies on each side of the question of the safety of marijuana use. I will present and evaluate the

reasoning used by each and conclude with a discussion of the value of different types of sources

in terms of the degree of support that they provide for their conclusions.

Presentation of an Argument that Marijuana Use is Safe

A large meta-study was performed by a group of researchers at UC San Diego focusing

on the long-term neurocognitive effects of cannabis use (Grant et al., 2003). The study analyzed

other studies that had been done, comparing data for 623 cannabis users against 409 non- or

minimal users. The researchers found that chronic users of marijuana showed minor decreases in

performance in the categories of learning and remembering, but no other significant effects. The

study concludes that cannabis is probably safe for use for medical purposes (2003).

The primary argument given may be represented in standard form as follows:

Premise 1: Combining data from studies that have been done on the effects of marijuana

use on cognitive function allows for a large data pool from which to draw strong

conclusions.

Premise 2: In six out of the eight cognitive areas studied, namely: reaction time, attention,

language, abstraction/executive, perceptual, and motor skills, no significant cognitive

impairment was found among marijuana users.

The paper begins with an introductory paragraph, allowing
readers to learn and see the importance of the research topic.

Introductory
paragraphs should
contain a preview of
what will be covered in
the rest of the paper.

Clear section
headings make
certain that the
paper is
organized and
make it easy
for instructors
to know that all
required
elements of the
assignment
have been
covered.

This
paragraph
introduces the
reader to the
source and
overviews its
findings.

The clearest way to
express an argument is in
standard form, with the
premises labeled and listed
above the conclusion.

The premises of the argument are not usually listed clearly within
articles (scholarly or otherwise). It is necessary for you to formulate
what you feel is the main argument given in the paper.

Premise 3: In the two areas in which cognitive impairment was found, learning and

memory, the effect was small and could have been affected by sample bias.

Premise 4: Medical use of marijuana tends not to involve long term use, resulting in even

more minor, if any, ill effects.

Premise 5: Medical use of marijuana is likely to have benefits that outweigh minor

amounts of harm.

Conclusion: Medical use of marijuana has “an acceptable margin of safety under the

more limited conditions of exposure that would likely obtain in a medical setting” (Grant

et al., 2003).

Evaluation of the Argument that Marijuana Use is Safe

The reasoning presented appears to be strong since the premises appear adequately to

support the idea that the potential harms are minor and either do not apply to medical use or are

outweighed by the benefits to be gained therefrom. The article also attempts to explain away the

negative effects in learning and memory, suggesting that they could be due to selection bias in

the articles reviewed or due to an insufficient time of non-use of the drug prior to the study

(Grant et al., 2003). If the article is right about that, then perhaps there is no significant

neurological harm even in those two areas. The article supplies substantial support for its

premises, since there is a large data pool, all of it gathered from scientific studies.

However, the article points out that there are limitations of the research, such as different

lengths of time within the studies since the last use of the drug and the question of whether long

term marijuana users may not have the same initial cognitive abilities as those that do not,

making causal inferences more difficult (2003).

The premises and
conclusion of your
argument should be put in
your own words. If some
passages are directly from
the source, then they
should occur within
quotation marks, with the
source cited.

After the argument is
given, there is a
paragraph detailing the
strength of the
reasoning (how certain
the premises make the
conclusion, assuming
that they are true).

This is a
comment
on the
amount of
support
for the
premises.

It is important to point out any weakness in the reasoning as
well. Sometimes these weaknesses are pointed out in the article
and not necessarily fallacious. Other times, you may notice
weaknesses in the reasoning that are not acknowledged within
the article itself. Either way, it is important to comment on any
such factors affecting the strength of the reasoning.

The instructions do not require that
you address ALL of the bullet
points listed, but states, “You may
address questions such as the
following.” I chose the ones that
seemed most relevant here.

Presentation of an Argument that Marijuana Use is Unsafe

On the other side of the issue, a study from 2016 seems to demonstrate the exact opposite

conclusion. The authors show that use of marijuana, especially by teens, has many long term

negative effects and is associated with a multitude of, including physical, psychiatric,

neurological, and social impairments (Feeney & Kampman, 2016). The argument presented can

be summarized as follows:

Premise 1: Marijuana is addictive (Volkow et al., 2014).

Premise 2: Marijuana causes breathing problems (Tashkin et al., 2002).

Premise 3: Marijuana may increase the likelihood of developing schizophrenia and other

psychiatric symptoms (Arseneault et al., 2004).

Premise 4: Marijuana causes long terms harms cognitive abilities, including attention,

memory, processing speed, and executive functioning (Thames et al., 2014).

Premise 5: Marijuana use by teens is correlated with lower academic achievement, job

performance, and social functioning in relationships (Palamar et al., 2014).

Premise 6: Marijuana use results in decreased psychomotor function, and reaction time,

causing driving risks (Neavyn et al., 2014).

Conclusion: Marijuana use can cause physical, psychological, neurological, and social

harm, especially when used by adolescents.

Evaluation of the Argument that Marijuana Use is Unsafe

The reasoning in the article seems quite strong. The conclusion seems to follow from the

premises since it mostly summarizes the research findings. Furthermore, the premises are well

supported since they are all based in scientific research studies.

However, there are some limitations in the strength of the reasoning (as noted within the

study). One of those limitations is that we are not sure in all cases if marijuana use is the cause of

It is good to supply section headings that
are as clear as possible about what the
section covers.

It is important to present
both arguments as
strongly as possible.
One of the points of this
assignment is to be able
to understand and
appreciate the strongest
arguments on each side
of issues (rather than to
take sides).

These
sentences
evaluate the
strength of
the reasoning
itself.

This sentence comments on the support for the
premises (which is a separate question from the
strength of the reasoning).

In addition to summarizing the strength of the reasoning
and support for the premises, it is important to note any
sources of weakness within the argument.

the impairment observed. For example, the article notes that the correlation with schizophrenia

may or may not be causal (Feeney & Kampman, 2016). Furthermore, most of the studies focus

on the use of marijuana by teens; therefore, these results may have limited application to

discussions of marijuana use among adults, especially those using it for medical purposes.

Evaluation of Arguments in Scholarly and Non-Scholarly Sources

Both of these scholarly sources supply quite a bit of evidence for their conclusions by

analyzing the data from multiple scientific studies. Non-scholarly sources, by contrast, frequently

make claims that are not supported at all, or are only supported by other partisan sources. One of

the non-scholarly sources I read does not explicitly cite any research at all, but only implies that

it exists (Foundation, n.d.). This allows non-scholarly sources, such as advocative web pages, to

make it sound as though the case for their position is much stronger than it actually is.

However, as we have seen, even scholarly sources are capable of contradicting each

other. This would not be surprising in non-scholarly sources, especially between sources with

advocative intent. It is more surprising to find contradictory results within scholarly sources.

However, there are possible ways to resolve these contradictions. One possibility comes

from noting that the first meta-study combined the data from its studies. Some of these specific

studies showed greater and lesser scores for various neurocognitive skills among marijuana

users, and the meta-study’s methodology allowed them to cancel each other out. The study on

the contrary side, on the other hand, simply cited one source each for the various harms, which

may have enabled the authors to select studies to cite that showed results more favorable to their

preferred conclusion.

This section
contrasts the
evidence given
by scholarly
sources (Week
3) with the
amount of
evidence given
by non-
scholarly
sources (from
Week 2).

Part of the point of
the Week 2 and
Week 3 assignments
is to contrast the
type of support that
one can find in
scholarly versus
non-scholarly
sources.

Some of the questions in the prompt for this
section are intended to be somewhat open-
ended … the purpose is to critically discuss
the sources of evidence, including the relative
strengths and weaknesses of each. This
analysis goes beyond just answering those
questions and focuses on an interesting related
issue about apparent contradictions one can
find even in scholarly research.

Thus, while non-scholarly sources can be clearly partisan and non-objective, pulling from

whichever sources, reliable or not, that support their point of view, even scholarly sources are

able to analyze data in ways that are far from neutral.

Conclusion:

Studying the reasoning on each side of the issue has been enlightening. Though there is

still debate, even among scholars, about the safety of marijuana use, studying the reasoning from

high quality sources gives perspective about the type of evidence that is being used on each side,

allowing one to assess which evidence is more reliable and provides more support for its

conclusion. In the future, I am more likely to go to scholarly sources over popular ones and to

analyze a multitude of scholarly results to understand the issue from a more well informed point

of view.

A simple concluding paragraph can contain
things such as thoughts on what one has
learned about the value of searching out
different types of sources.

References

Arseneault, L., Cannon, M., Witton, J., & Murray, R. M. (2004). Causal association between

cannabis and psychosis: Examination of the evidence. British Journal of

Psychiatry, 184(2), 110-117. https://doi.org/10.1192/bjp.184.2.110

Feeney, K. E., & Kampman, K. M. (2016). Adverse effects of marijuana use. The Linacre

Quarterly, 83(2), 174-178. https://doi.org/10.1080/00243639.2016.1175707

Foundation for a Drug Free World. (n.d.). The truth about marijuana: Behind the smoke screen.

http://www.drugfreeworld.org/drugfacts/marijuana/behind-the-smoke-screen.html

Grant, I., Gonzales, R., Carey, C., Natarajan, L., & Wolfson, T. (2003). Non-acute (residual)

neurocognitive effects of cannabis use: A meta-analytic study. Journal of the

International Neuropsychological Society, 9(5), 679-689.

https://doi.org/10.1017/S1355617703950016

Neavyn, M. J., Blohm, E., Babu, K. M., & Bird, S. B. (2014). Medical marijuana and driving: A

review. Journal of Medical Toxicology, 10(3), 269-279. https://doi.org/10.1007/s13181-

014-0393-4

Palamar, J. J., Fenstermaker, M., Kamboukos, D., Ompad, D. C., Cleland, C. M., & Weitzman,

M. (2014). Adverse psychosocial outcomes associated with drug use among US high

school seniors: A comparison of alcohol and marijuana. American Journal of Drug and

Alcohol Abuse, 40(6), 438-446. https://doi.org/10.3109/00952990.2014.943371

Tashkin, D. P., Baldwin, G. C., Sarafian, T., Dubinett, S., & Roth, M. D. (2002). Respiratory and

immunologic consequences of marijuana smoking. Journal of Clinical

Pharmacology, 42(S1), 71S-81S. https://doi.org/10.1002/j.1552-4604.2002.tb06006.x

Always have a reference section that contains
citations for all of the sources that you use
within the article.

Thames, A. D., Arbid, N., & Sayegh, P. (2014). Cannabis use and neurocognitive functioning in

a non-clinical sample of users. Addictive Behaviors, 39(5), 994-999.

https://doi.org/10.1016/j.addbeh.2014.01.019

Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. B. (2014). Adverse health effects

of marijuana use. New England Journal of Medicine, 370, 2219-2227.

https://doi.org/10.1056/NEJMra1402309

You do not have to have this many resources, only
the number required in the assignment
instructions.

Sex education

Is Marijuana Use Safe?

Modeled example for the Week 3 assignment

John Smith

University of Arizona Global Campus

PHI103 Informal Logic

Dr. Christopher Foster

Due: Day 7 of Week 3

Begin with a title page,

formatted according to

APA standards.

With many states legalizing both medical and recreational marijuana, an important

question for voters, legislators, and potential users is whether marijuana is safe. There have been

many studies done on the topic, with findings on both sides. The focus of this paper will be to

present scholarly research on both sides of the question and to evaluate the quality of each. To

provide the most reliable information possible, I have chosen to present the findings of meta-

studies on each side of the question of the safety of marijuana use. I will present and evaluate the

reasoning used by each and conclude with a discussion of the value of different types of sources

in terms of the degree of support that they provide for their conclusions.

Presentation of an Argument that Marijuana Use is Safe

A large meta-study was performed by a group of researchers at UC San Diego focusing

on the long-term neurocognitive effects of cannabis use (Grant et al., 2003). The study analyzed

other studies that had been done, comparing data for 623 cannabis users against 409 non- or

minimal users. The researchers found that chronic users of marijuana showed minor decreases in

performance in the categories of learning and remembering, but no other significant effects. The

study concludes that cannabis is probably safe for use for medical purposes (2003).

The primary argument given may be represented in standard form as follows:

Premise 1: Combining data from studies that have been done on the effects of marijuana

use on cognitive function allows for a large data pool from which to draw strong

conclusions.

Premise 2: In six out of the eight cognitive areas studied, namely: reaction time, attention,

language, abstraction/executive, perceptual, and motor skills, no significant cognitive

impairment was found among marijuana users.

The paper begins with an introductory paragraph, allowing
readers to learn and see the importance of the research topic.

Introductory
paragraphs should
contain a preview of
what will be covered in
the rest of the paper.

Clear section
headings make
certain that the
paper is
organized and
make it easy
for instructors
to know that all
required
elements of the
assignment
have been
covered.

This
paragraph
introduces the
reader to the
source and
overviews its
findings.

The clearest way to
express an argument is in
standard form, with the
premises labeled and listed
above the conclusion.

The premises of the argument are not usually listed clearly within
articles (scholarly or otherwise). It is necessary for you to formulate
what you feel is the main argument given in the paper.

Premise 3: In the two areas in which cognitive impairment was found, learning and

memory, the effect was small and could have been affected by sample bias.

Premise 4: Medical use of marijuana tends not to involve long term use, resulting in even

more minor, if any, ill effects.

Premise 5: Medical use of marijuana is likely to have benefits that outweigh minor

amounts of harm.

Conclusion: Medical use of marijuana has “an acceptable margin of safety under the

more limited conditions of exposure that would likely obtain in a medical setting” (Grant

et al., 2003).

Evaluation of the Argument that Marijuana Use is Safe

The reasoning presented appears to be strong since the premises appear adequately to

support the idea that the potential harms are minor and either do not apply to medical use or are

outweighed by the benefits to be gained therefrom. The article also attempts to explain away the

negative effects in learning and memory, suggesting that they could be due to selection bias in

the articles reviewed or due to an insufficient time of non-use of the drug prior to the study

(Grant et al., 2003). If the article is right about that, then perhaps there is no significant

neurological harm even in those two areas. The article supplies substantial support for its

premises, since there is a large data pool, all of it gathered from scientific studies.

However, the article points out that there are limitations of the research, such as different

lengths of time within the studies since the last use of the drug and the question of whether long

term marijuana users may not have the same initial cognitive abilities as those that do not,

making causal inferences more difficult (2003).

The premises and
conclusion of your
argument should be put in
your own words. If some
passages are directly from
the source, then they
should occur within
quotation marks, with the
source cited.

After the argument is
given, there is a
paragraph detailing the
strength of the
reasoning (how certain
the premises make the
conclusion, assuming
that they are true).

This is a
comment
on the
amount of
support
for the
premises.

It is important to point out any weakness in the reasoning as
well. Sometimes these weaknesses are pointed out in the article
and not necessarily fallacious. Other times, you may notice
weaknesses in the reasoning that are not acknowledged within
the article itself. Either way, it is important to comment on any
such factors affecting the strength of the reasoning.

The instructions do not require that
you address ALL of the bullet
points listed, but states, “You may
address questions such as the
following.” I chose the ones that
seemed most relevant here.

Presentation of an Argument that Marijuana Use is Unsafe

On the other side of the issue, a study from 2016 seems to demonstrate the exact opposite

conclusion. The authors show that use of marijuana, especially by teens, has many long term

negative effects and is associated with a multitude of, including physical, psychiatric,

neurological, and social impairments (Feeney & Kampman, 2016). The argument presented can

be summarized as follows:

Premise 1: Marijuana is addictive (Volkow et al., 2014).

Premise 2: Marijuana causes breathing problems (Tashkin et al., 2002).

Premise 3: Marijuana may increase the likelihood of developing schizophrenia and other

psychiatric symptoms (Arseneault et al., 2004).

Premise 4: Marijuana causes long terms harms cognitive abilities, including attention,

memory, processing speed, and executive functioning (Thames et al., 2014).

Premise 5: Marijuana use by teens is correlated with lower academic achievement, job

performance, and social functioning in relationships (Palamar et al., 2014).

Premise 6: Marijuana use results in decreased psychomotor function, and reaction time,

causing driving risks (Neavyn et al., 2014).

Conclusion: Marijuana use can cause physical, psychological, neurological, and social

harm, especially when used by adolescents.

Evaluation of the Argument that Marijuana Use is Unsafe

The reasoning in the article seems quite strong. The conclusion seems to follow from the

premises since it mostly summarizes the research findings. Furthermore, the premises are well

supported since they are all based in scientific research studies.

However, there are some limitations in the strength of the reasoning (as noted within the

study). One of those limitations is that we are not sure in all cases if marijuana use is the cause of

It is good to supply section headings that
are as clear as possible about what the
section covers.

It is important to present
both arguments as
strongly as possible.
One of the points of this
assignment is to be able
to understand and
appreciate the strongest
arguments on each side
of issues (rather than to
take sides).

These
sentences
evaluate the
strength of
the reasoning
itself.

This sentence comments on the support for the
premises (which is a separate question from the
strength of the reasoning).

In addition to summarizing the strength of the reasoning
and support for the premises, it is important to note any
sources of weakness within the argument.

the impairment observed. For example, the article notes that the correlation with schizophrenia

may or may not be causal (Feeney & Kampman, 2016). Furthermore, most of the studies focus

on the use of marijuana by teens; therefore, these results may have limited application to

discussions of marijuana use among adults, especially those using it for medical purposes.

Evaluation of Arguments in Scholarly and Non-Scholarly Sources

Both of these scholarly sources supply quite a bit of evidence for their conclusions by

analyzing the data from multiple scientific studies. Non-scholarly sources, by contrast, frequently

make claims that are not supported at all, or are only supported by other partisan sources. One of

the non-scholarly sources I read does not explicitly cite any research at all, but only implies that

it exists (Foundation, n.d.). This allows non-scholarly sources, such as advocative web pages, to

make it sound as though the case for their position is much stronger than it actually is.

However, as we have seen, even scholarly sources are capable of contradicting each

other. This would not be surprising in non-scholarly sources, especially between sources with

advocative intent. It is more surprising to find contradictory results within scholarly sources.

However, there are possible ways to resolve these contradictions. One possibility comes

from noting that the first meta-study combined the data from its studies. Some of these specific

studies showed greater and lesser scores for various neurocognitive skills among marijuana

users, and the meta-study’s methodology allowed them to cancel each other out. The study on

the contrary side, on the other hand, simply cited one source each for the various harms, which

may have enabled the authors to select studies to cite that showed results more favorable to their

preferred conclusion.

This section
contrasts the
evidence given
by scholarly
sources (Week
3) with the
amount of
evidence given
by non-
scholarly
sources (from
Week 2).

Part of the point of
the Week 2 and
Week 3 assignments
is to contrast the
type of support that
one can find in
scholarly versus
non-scholarly
sources.

Some of the questions in the prompt for this
section are intended to be somewhat open-
ended … the purpose is to critically discuss
the sources of evidence, including the relative
strengths and weaknesses of each. This
analysis goes beyond just answering those
questions and focuses on an interesting related
issue about apparent contradictions one can
find even in scholarly research.

Thus, while non-scholarly sources can be clearly partisan and non-objective, pulling from

whichever sources, reliable or not, that support their point of view, even scholarly sources are

able to analyze data in ways that are far from neutral.

Conclusion:

Studying the reasoning on each side of the issue has been enlightening. Though there is

still debate, even among scholars, about the safety of marijuana use, studying the reasoning from

high quality sources gives perspective about the type of evidence that is being used on each side,

allowing one to assess which evidence is more reliable and provides more support for its

conclusion. In the future, I am more likely to go to scholarly sources over popular ones and to

analyze a multitude of scholarly results to understand the issue from a more well informed point

of view.

A simple concluding paragraph can contain
things such as thoughts on what one has
learned about the value of searching out
different types of sources.

References

Arseneault, L., Cannon, M., Witton, J., & Murray, R. M. (2004). Causal association between

cannabis and psychosis: Examination of the evidence. British Journal of

Psychiatry, 184(2), 110-117. https://doi.org/10.1192/bjp.184.2.110

Feeney, K. E., & Kampman, K. M. (2016). Adverse effects of marijuana use. The Linacre

Quarterly, 83(2), 174-178. https://doi.org/10.1080/00243639.2016.1175707

Foundation for a Drug Free World. (n.d.). The truth about marijuana: Behind the smoke screen.

http://www.drugfreeworld.org/drugfacts/marijuana/behind-the-smoke-screen.html

Grant, I., Gonzales, R., Carey, C., Natarajan, L., & Wolfson, T. (2003). Non-acute (residual)

neurocognitive effects of cannabis use: A meta-analytic study. Journal of the

International Neuropsychological Society, 9(5), 679-689.

https://doi.org/10.1017/S1355617703950016

Neavyn, M. J., Blohm, E., Babu, K. M., & Bird, S. B. (2014). Medical marijuana and driving: A

review. Journal of Medical Toxicology, 10(3), 269-279. https://doi.org/10.1007/s13181-

014-0393-4

Palamar, J. J., Fenstermaker, M., Kamboukos, D., Ompad, D. C., Cleland, C. M., & Weitzman,

M. (2014). Adverse psychosocial outcomes associated with drug use among US high

school seniors: A comparison of alcohol and marijuana. American Journal of Drug and

Alcohol Abuse, 40(6), 438-446. https://doi.org/10.3109/00952990.2014.943371

Tashkin, D. P., Baldwin, G. C., Sarafian, T., Dubinett, S., & Roth, M. D. (2002). Respiratory and

immunologic consequences of marijuana smoking. Journal of Clinical

Pharmacology, 42(S1), 71S-81S. https://doi.org/10.1002/j.1552-4604.2002.tb06006.x

Always have a reference section that contains
citations for all of the sources that you use
within the article.

Thames, A. D., Arbid, N., & Sayegh, P. (2014). Cannabis use and neurocognitive functioning in

a non-clinical sample of users. Addictive Behaviors, 39(5), 994-999.

https://doi.org/10.1016/j.addbeh.2014.01.019

Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. B. (2014). Adverse health effects

of marijuana use. New England Journal of Medicine, 370, 2219-2227.

https://doi.org/10.1056/NEJMra1402309

You do not have to have this many resources, only
the number required in the assignment
instructions.

Sex education

Write a paper that includes the following:

Should sex education be taught in public schools?

• Must be three to five double-spaced pages in length (not including title and
references pages and formatted according to APA Style (Links to an
external site.) as outlined in the Writing Center’s APA Formatting for
Microsoft Word (Links to an external site.) resource.

• Must include a separate title page with the following:
o Title of paper in bold font

▪ Space should appear between the title and the
rest of the information on the title page.

o Student’s name
o Name of institution (University of Arizona Global Campus)
o Course name and number
o Instructor’s name
o Due date

Introduction (approximately 100 words)

• Explain your topic and state the specific question that you are addressing.

Presentation of an Argument (approximately 200 words)

• Describe the scholarly source on one side of the issue.
• Present what you see as the main argument from that source (present the

argument in standard form, with the premises listed above the conclusion).

Evaluation of the quality of the reasoning in this source (approximately 200 words)
You may address questions such as the following:

• How adequately does the article support the premises of the argument?
• How strongly do the premises of the argument support the truth of the

conclusion?
• What (if any) missing premises would be needed to complete the argument

(make it valid/strong)? Are these missing premises justified or merely
assumptions?

Presentation of an Opposing Argument (approximately 200 words)

• Describe the scholarly source on the other side of the issue.
• Present what you see as the main argument from that source in standard

form, with the premises listed above the conclusion.

Evaluation of the quality of the reasoning in this source (approximately 200 words)
You may address questions such as the following:

• How adequately does the article support the premises of the argument?
• How strongly do the premises of the argument support the truth of the

conclusion?
• What (if any) missing premises would be needed to complete the argument

(make it valid/strong)? Are these missing premises justified or merely
assumptions?

Evaluation of Arguments in Non-Scholarly and Scholarly Sources (approximately
100 words)

• Discuss the differences in the quality of the reasoning or in the degree of
support for premises in these scholarly sources contrasted with non-
scholarly sources.

o If you need support, review the Scholarly and Popular
Resources (1) (Links to an external site.) Writing Center video.

Conclusion (approximately 50 words)

• Reflect on how this activity might influence how you conduct research in the
future

• Helpful Watch the videos
• What Is a “STRONG” argument? (Links to an external site.)
• What Is an Inductive Argument? (Links to an external site.)
• Inductive Reasoning (Links to an external site.)
• Inference to the Best Explanation (Links to an external site.)

Below is the topic I chose and the Premise’s can be altered and argument but the topic
remains the same. The scholarly articles are attached as well.

Topic : Should sex education be taught in public schools?

Argument

Premise 1: Educating teens in school about sex education can prevent unwanted
pregnancies and STD’s.

Premise 2: Sex education can teach teen how to practice abstinence .

Premise 3: Teens can speak among peers on question about sexual activities in sex ed
classes.

Conclusion: ..Therefore properly being informed about sex education in school could
reduce

Against Argument

Premise 1: …. Sex education is seen as a promotion for sexual activities for teens.

Premise 2: ….Teens pregnancies are at an alarming rate sex education isn’t working.

Premise 3: …. Sex education should be done by parents instead of school officials.

Conclusion: …. In other word parents should be involved in the sexual education of their
teens.

References
Dent, L., & Maloney, P. (2017). Evangelical Christian parents’ attitudes towards abstinence-based sex
education: ‘I want my kids to have great sex!’ Sex Education, 17(2), 149–
164. https://doi.org/10.1080/14681811.2016.1256281

References

McKee, C., Ragsdale, K., & Southward, L. H. (2014). What Do Parents
in Mississippi Really Think About Sex Education in Schools? Results of
a State-Level Survey. Journal of Health Disparities Research &
Practice, 7(1), 97–119

references
Stanger-Hall, K. F., & Hall, D. W. (2011). Abstinence-Only Education
and Teen Pregnancy Rates: Why We Need Comprehensive Sex
Education in the U.S. PLoS ONE, 6(10), 1–
11. https://doi.org/10.1371/journal.pone.0024658

(American Psychological Assoc.)

References
Finkel, M. L., & Finkel, S. (1985). Sex Education in High
School. Society, 23(1), 48–52. https://doi.org/10.1007/BF02695869

eferences
Bloch D. (1979). Attitudes of mothers toward sex education. American
Journal of Public Health, 69(9), 911–915.

Sex education

Abstinence-Only Education and Teen Pregnancy Rates:
Why We Need Comprehensive Sex Education in the U.S.
Kathrin F. Stanger-Hall1*, David W. Hall2

1 Department of Plant Biology, The University of Georgia, Athens, Georgia, United States of America, 2 Department of Genetics, The University of Georgia, Athens,

Georgia, United States of America

Abstract

The United States ranks first among developed nations in rates of both teenage pregnancy and sexually transmitted
diseases. In an effort to reduce these rates, the U.S. government has funded abstinence-only sex education programs for
more than a decade. However, a public controversy remains over whether this investment has been successful and whether
these programs should be continued. Using the most recent national data (2005) from all U.S. states with information on sex
education laws or policies (N = 48), we show that increasing emphasis on abstinence education is positively correlated with
teenage pregnancy and birth rates. This trend remains significant after accounting for socioeconomic status, teen
educational attainment, ethnic composition of the teen population, and availability of Medicaid waivers for family planning
services in each state. These data show clearly that abstinence-only education as a state policy is ineffective in preventing
teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S. In alignment with the
new evidence-based Teen Pregnancy Prevention Initiative and the Precaution Adoption Process Model advocated by the
National Institutes of Health, we propose the integration of comprehensive sex and STD education into the biology
curriculum in middle and high school science classes and a parallel social studies curriculum that addresses risk-aversion
behaviors and planning for the future.

Citation: Stanger-Hall KF, Hall DW (2011) Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S.. PLoS
ONE 6(10): e24658. doi:10.1371/journal.pone.0024658

Editor: Virginia J. Vitzthum, Indiana University, United States of America

Received March 8, 2011; Accepted August 16, 2011; Published October 14, 2011

Copyright: � 2011 Stanger-Hall, Hall. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This work was funded by the University of Georgia Research Foundation. The funders had no role in study design, data collection and analysis, decision
to publish, or preparation of the manuscript.

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: ksh@uga.edu

Introduction

The appropriate type of sex education that should be taught in

U.S. public schools continues to be a major topic of debate, which

is motivated by the high teen pregnancy and birth rates in the

U.S., compared to other developed countries [1–4] (Table 1).

Much of this debate has centered on whether abstinence-only

versus comprehensive sex education should be taught in public

schools. Some argue that sex education that covers safe sexual

practices, such as condom use, sends a mixed message to students

and promotes sexual activity. This view has been supported by the

US government, which promotes abstinence-only initiatives

through the Adolescent Family Life Act (AFLA), Community-

Based Abstinence Education (CBAE) and Title V, Section 510 of

the Personal Responsibility and Work Opportunity Reconciliation

Act of 1996 (welfare reform), among others [5]. Funding for

abstinence-only programs in 2006 and 2007 was $176 million

annually (before matching state funds) [5,6]. The central message

of these programs is to delay sexual activity until marriage, and

under the federal funding regulations most of these programs

cannot include information about contraception or safer-sex

practices [5,7].

The federal funding for abstinence-only education expired on

June 30, 2009, and no funds were allocated for the FY 2010

budget. Instead, a ‘‘Labor-Health and Human Services, Education

and Other Agencies’’ appropriations bill including a total of $114

million for a new evidence-based Teen Pregnancy Prevention

Initiative for FY 2010 was signed into law in December 2009. This

constitutes the first large-scale federal investment dedicated to

preventing teen pregnancy through research- and evidence-based

efforts. However, despite accumulating evidence that abstinence-

only programs are ineffective [6,8], abstinence-only funding

(including Title V funding) was restored on September 29, 2009

[8] for 2010 and beyond by including $250 million of mandatory

abstinence-only funding over 5 years as part of an amendment to

the Senate Finance Committee’s health-reform legislation (HR

3590, Amendment #2786, section 2954). This was authorized by
the legislature on March 23, 2010 [9].

With two types of federal funding programs available, legislators

of individual states now have the opportunity to decide which type

of sex education (and which funding option) to choose for their

state, while pursuing the ultimate goal of reducing teen pregnancy

rates. This large-scale analysis aims to provide scientific evidence

for this decision by evaluating the most recent data on the

effectiveness of different sex education programs with regard to

preventing teen pregnancy for the U.S. as a whole. We used the

most recent teenage pregnancy, abortion and birth data from all

U.S. states along with information on each state’s prescribed sex

education approach to ask ‘‘what is the quantitative evidence that

abstinence-only education is effective in reducing U.S. teen

pregnancy rates?’’ If abstinence education results in teenagers

being abstinent, teenage pregnancy and birth rates should be

PLoS ONE | www.plosone.org 1 October 2011 | Volume 6 | Issue 10 | e24658

lower in those states that emphasize abstinence more. Other

factors may also influence teenage pregnancy and birth rates,

including socio-economic status, education, cultural influences

[10–12], and access to contraception through Medicaid waivers

[13–15] and such effects must be parsed out statistically to

examine the relationship between sex education and teen

pregnancy and birth rates. It was the goal of this study to evaluate

the current sex-education approach in the U.S., and to identify the

most effective educational approach to reduce the high U.S. teen

pregnancy rates. Based on a national analysis of all available state

data, our results clearly show that abstinence-only education does

not reduce and likely increases teen pregnancy rates. Compre-

hensive sex and/or STD education that includes abstinence as a

desired behavior was correlated with the lowest teen pregnancy

rates across states. In alignment with the Precaution Adoption Process

Model advocated by the National Institutes of Health we suggest

that comprehensive sex and HIV/STD education should be

taught as part of the biology curriculum in middle and high school

science classes, along with a social studies curriculum that

addresses risk-aversion behaviors and planning for the future.

Materials and Methods

Level of emphasis on abstinence in state laws
Data on abstinence education were retrieved from the

Education Commission of the States [16]. Of the 50 U.S. states,

only 38 states had sex education laws (as of 2007; Table 2). Thirty

of the 38 state laws contained abstinence education provisions, 8

states did not. Following the analysis of the Editorial Projects in

Education Research Center [17], which categorizes the data on

abstinence education into four levels (from least to most emphasis

on abstinence: no provision, abstinence covered, abstinence

promoted, abstinence stressed), we assigned ordinal values from

0 through 3 to each of these four categories respectively. A higher

category value indicates more emphasis on abstinence with level 3

stressing abstinence only until marriage as the fundamental

teaching standard (similar to the federal definition of abstinence-

only education), if sex or HIV/STD education is taught (sex

education is not required in most states) [16–18]. The primary

emphasis of a level 2 provision is to promote abstinence in school-

aged teens if sex education or HIV/STD education is taught, but

discussion of contraception is not prohibited. Level 1 covers

abstinence for school-aged teens as part of a comprehensive sex or

HIV/STD education curriculum, which should include medically

accurate information on contraception and protection from HIV/

STDs [16–18]. Level 0 laws on sex education and/or HIV

education do not specifically mention abstinence.

Level of emphasis on abstinence in state laws & policies
States without sex education laws may nevertheless have policies

regarding sex and/or HIV/STD education. These policies may be

published as Health Education standards or Public Education

codes [19]. These policies can also provide information on how

existing sex education laws may be interpreted by local school

boards. Information on the sex education laws and policies for all

50 US states was retrieved from the website of the Sexuality

Information and Education Council of the US (SIECUS). We

analyzed the 2005 state profiles on sex education laws and policy

data for all 50 states [19] following the criteria of the Editorial

Projects in Education Research Center [17] to identify the level of

abstinence education (Table 2). The coding for the state laws

(N = 38) and the coding for both laws and policies (N = 48) was

more or less the same for the states represented in both data sets

with 6 exceptions (Table 2): the additional information on policies

moved two states from a level 0 (abstinence not mentioned) to level

1 (abstinence covered), and four states from a level 2 abstinence

provision (abstinence emphasized) to a level 3 (abstinence stressed).

Only two states had neither a state law nor a policy regarding sex

or STD/HIV education (as of 2005): North Dakota and

Wyoming. Analyses of the two data sets gave essentially identical

results. In this paper we present the analyses of the more extensive

(48 states) law and policy data set.

Teen pregnancy, abortion and birth data
Data on teen pregnancy, birth and abortion rates were retrieved

for the 48 states from the most recent national reports, which

cover data through 2005 [11,12]. The data are reported as

number of teen pregnancies, teen births or teen abortions per one

thousand female teens between 15 and 19 years of age. In general,

teen pregnancy rates are calculated based on reported teen birth

and abortion rates, along with an estimated miscarriage rate [12].

We used these data to determine whether there is a significant

correlation between level of prescribed abstinence education and

teen pregnancy and birth rates across states. The expectation is

that higher levels of abstinence education will be correlated with

higher levels of abstinence behavior and thus lower levels of teen

pregnancy.

Other factors
Data on four possibly confounding factors were included in our

analyses.

Socio-economics. To account for cost-of-living differences

across the US, we used the adjusted median household income for

2006 for each state from the Council for Community and

Economic Research: C2ER [20]. These data are based on median

household income from the Current Population Survey for 2006 from

the U.S. Census Bureau [21] and the 2006 cost of living index

(COLI).

Educational attainment. As an estimate of statewide

education levels among teens, we used the percentage of high

school graduates that took the SAT in 2005/2006 in each state

[22].

Ethnic composition. We determined the proportion of the

three major ethnic groups (white, black, Hispanic) in the teen

population (15–19 years old) for each state [12], and assessed

whether the teen pregnancy, abortion and birth rates across states

Table 1. U.S. teenage pregnancy and birth rates are high compared to other developed countries.

International Data U.S. France Germany Netherlands Canada UK

Pregnancy rate (2002–5) 72.2 25.7 18.8 11.8 29.2 41.3‘

Birth rate (2006) 41.9 7.8 10.1 3.8 13.3 26.7

Rates are listed as numbers per 1000 girls 15–19 years old,
‘15–18 years old [1–4].
doi:10.1371/journal.pone.0024658.t001

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were correlated with the ethnic composition of the teen

population. To account for the ethnic diversity among the teen

populations in the different states in a multivariate analysis of teen

pregnancy and birth rates, we included only the proportion of

white and black teens in the state populations as covariates,

because the Hispanic teen population numbers were not normally

distributed (see below).

Medicaid waivers for family planning. Medicaid-funded

access to contraceptives and family planning services has been

shown to decrease the incidence of unplanned pregnancies,

especially among low-income women and teens [13]. According

to the Guttmacher Institute, the national family planning program

prevents 1.94 million unintended pregnancies, including almost

400,000 teen pregnancies each year by providing millions of young

and low-income women access to voluntary contraceptive services

[13], Medicaid covered 71% of expenditures for these programs in

2006, and it is estimated that states saved $4 (associated with

unintended births) for each $1 spend on contraceptive services

[13]. Since the increasing role of Medicaid in funding family

planning was mainly due to the efforts of 21 states to expand

eligibility for family planning for low-income women who

otherwise would not qualify for Medicaid, we analyzed whether

these Medicaid waivers for family planning services (available in

some states but not in others) could bias our results. We

determined which states had received permission (as of 2005)

from the Federal Medicaid program to extend Medicaid eligibility

for family planning services to large numbers of individuals whose

incomes are above the state-set levels for Medicaid enrollment

[15]. We assessed whether the waivers (access to family planning

services) had an effect on our analysis of teen pregnancy and birth

rates across states, specifically whether they could bias our analysis

with respect to the effects of the different levels of abstinence

education.

Statistical Analyses
Sample statistics. Using JMP 8 software [23], we tested all

variables for normality (Goodness of Fit: Shapiro Wilkes Test; JMP

8.0). Except for teen abortion rates and Hispanic teen population

data, all variables were normally distributed. The distribution of

the Hispanic teen population across states was not normal: most

states had relatively small Hispanic teen populations, and a few

states had a relatively large population of Hispanic teens. Teen

pregnancy and birth rate distributions included outliers, but these

outliers did not cause the distributions within abstinence education

levels to differ significantly from normal, thus all outliers were

included in subsequent analyses. For all further statistical analyses

we used SPSS [24].

Correlations. We used non-parametric (Spearman)

correlations to assess relationships between variables, and for

normally distributed variables we also used parametric (Pearson)

correlations, but these results showed the same trends and

Table 2. Abstinence provisions and levels of abstinence
education in state laws & policies.

State Law: Abstinence1 Law Level2
Laws & Policy
Level3

Alabama Yes 3 3

Alaska – – 1

Arizona Yes 2 3

Arkansas Yes 2 3

California Yes 1 1

Colorado Yes 2 2

Connecticut No 0 0

Delaware – – 3

Florida Yes 3 3

Georgia Yes 2 2

Hawaii – – 3

Idaho No 0 0

Illinois Yes 3 3

Indiana Yes 3 3

Iowa No 0 0

Kansas – – 0

Kentucky – – 3

Louisiana Yes 3 3

Maine Yes 1 1

Maryland – – 0

Massachusetts No 0 1

Michigan Yes 1 1

Minnesota Yes 1 1

Mississippi Yes 3 3

Missouri Yes 2 2

Montana – – 0

Nebraska – – 2

Nevada No 0 0

New Hampshire No 0 0

New Jersey Yes 1 1

New Mexico – – 3

New York – – 1

North Carolina Yes 3 3

North Dakota – – –

Ohio Yes 3 3

Oklahoma Yes 3 3

Oregon Yes 1 1

Pennsylvania Yes 2 3

Rhode Island Yes 2 3

South Carolina Yes 3 3

South Dakota Yes 2 2

Tennessee Yes 3 3

Texas Yes 3 3

Utah Yes 3 3

Vermont Yes 1 1

Virginia Yes 2 2

Washington Yes 2 2

West Virginia No 0 0

State Law: Abstinence1 Law Level2
Laws & Policy
Level3

Wisconsin No 0 1

Wyoming – – –

1
State laws with (yes) or without (no) an abstinence provision as of 2007 [16].

2Level of Abstinence provision in state law as of 2007 [17].
3
Level of Abstinence provision in state law or other policy as of 2005 [19];
differences to laws2 are noted in italics.

doi:10.1371/journal.pone.0024658.t002

Table 2. Cont.

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significance levels as the non-parametric correlations. As a result,

we only report the results for the non-parametric correlations here.

Multivariate analyses. Only the two normally distributed

dependent variables were included in the multivariate analysis

(MANOVA and MANCOVA [24]): teen pregnancy and teen

birth rates. We tested for homogeneity of error variances (Levene’s

Test) and for equality of covariance matrices (Box test) between

groups. For MANCOVA we report the estimated marginal means

of teen pregnancy and birth rates (i.e. means after the influence of

covariates was removed). For pairwise comparison between

abstinence levels, we used the Bonferroni adjustment for

multiple comparisons.

Results

Among the 48 states in this analysis (all U.S. states except North

Dakota and Wyoming), 21 states stressed abstinence-only

education in their 2005 state laws and/or policies (level 3), 7

states emphasized abstinence education (level 2), 11 states covered

abstinence in the context of comprehensive sex education (level 1),

and 9 states did not mention abstinence (level 0) in their state laws

or policies (Figure 1). In 2005, level 0 states had an average (6

standard error) teen pregnancy rate of 58.78 (64.96), level 1 states

averaged 56.36 (63.94), level 2 states averaged 61.86 (63.93), and

level 3 states averaged 73.24 (62.58) teen pregnancies per 1000

girls aged 14–19 (Table 3). The level of abstinence education (no

provision, covered, promoted, stressed) was positively correlated

with both teen pregnancy (Spearman’s rho = 0.510, p = 0.001) and

teen birth (rho = 0.605, p,0.001) rates (Table 4), indicating that

abstinence education in the U.S. does not cause abstinence

behavior. To the contrary, teens in states that prescribe more

abstinence education are actually more likely to become pregnant

(Figure 2). Abortion rates were not correlated with abstinence

education level (rho = 20.136, p = 0.415). A multivariate analysis

of teen pregnancy and birth rates identified the level of abstinence

education as a significant influence on teen pregnancy and birth

rates across states (pregnancies F = 5.620, p = 0.002; births

F = 11.814, p,0.001). The significant pregnancy effect was caused

by significantly lower pregnancy rates in level 0 (no abstinence

provision) states compared to level 3 (abstinence stressed) states

(p = 0.036), and level 1 (abstinence covered) states compared to

level 3 states (p = 0.005); the significant birth effect was caused by

significantly lower teen birth rates in level 0 states compared to

level 3 (p = 0.006) states, and significantly lower teen birth rates in

level 1 states compared to level 3 states (p,0.001).

Socio-economic status, educational attainment, and ethnic

differences across states exhibited significant correlations with some

variables in our model (Table 4). We examined the influence of each

possible confounding factor on our analysis by including them as

covariates in several multivariate analyses. However, after accounting

for the effects of these covariates, the effect of abstinence education on

teenage pregnancy and birth rates remained significant (Figure 3).

Socio-economic status
There was a significant negative correlation between median

household income (adjusted for cost of living) and level of abstinence

education (rho = 20.349, p = 0.015; Table 4), indicating a socio-

economic bias at the state level on state laws and regulations with

regard to sex education. The adjusted median household income

was negatively correlated with teen pregnancy (rho = 20.383,

p = 0.007) and birth (rho = 20.296, p = 0.041) rates across states:

pregnancy and birth rates tended to be higher in lower-income

states. There was no correlation between household income and

abortion rates (rho = 20.116, p = 0.432). When including the

adjusted median household income as a covariate in a multivariate

analysis (evaluated at $45,892), income significantly influenced teen

pregnancy (F = 5.427, p = 0.025) but not birth (F = 2.216, p = 0.144)

rates. After accounting for socioeconomic status, the level of

abstinence education still had a significant effect on teen pregnancy

(F = 4.103, p = 0.012) and birth rates (F = 10.480, p,0.001).

Educational attainment
There was no significant correlation between statewide teen

education (percentage of high school graduates that took the SAT

in 2005/2006) and level of abstinence education (rho = 20.156,

p = 0.291). Education was not correlated with teen pregnancy rates

(rho = 20.014, p = 0.925), but it was positively correlated with teen

abortion rates (rho = 0.662, p,0.001), and as a consequence,

negatively correlated with teen birth rates (rho = 20.412,

p = 0.004). There was no correlation between socio-economic

status and teen educational attainment across states (rho = 20.048,

p = 0.748), suggesting that these trends apply to both rich and poor

states. When including education (% graduates taking the SAT) as

a covariate in a multivariate analysis, education had a significant

influence on teen birth (F = 8.308, p = 0.006), but not on teen

pregnancy (F = 0.161, p = 0.690) rates, and after accounting for

the influence of teen education (evaluated at 39.7% of graduates

taking the SAT), the level of abstinence education still had a

significant effect on both teen pregnancy (F = 5.527, p = 0.003)

and teen birth rates (F = 10.772, p,0.001).

Ethnic composition
For this analysis we focused on the three largest ethnic groups

for which data are available: white, black, and Hispanic [12]. Teen

pregnancy rates differ across these three ethnic groups. For the 48

states in this analysis, an ethnic breakdown (for all three ethnic

groups) of teen pregnancy and abortion rates was available for 26

states, and of teen birth rates for 43 states. Across this reduced

sample of states, 2005 teen pregnancy rates averaged 48.1 (61.95)

pregnancies per 1000 white teens, 103.7 (65.38) pregnancies per

1000 black teens, and 141.6 (68.55) pregnancies per 1000

Figure 1. Abstinence education level prescribed in 2005 state
laws or policies. All 48 states with state laws or policies on sex and/or
HIV education are shown (North Dakota and Wyoming are not
represented).
doi:10.1371/journal.pone.0024658.g001

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Hispanic teens. Teen birth rates averaged 27.6 (61.5) births per

1000 white teens, 59.2 (62.58) births per 1000 black teens, and

96.1 (65.39) births per 1000 Hispanic teens. Abstinence education

levels were positively correlated with teen birth rates in all three

ethnic groups (white: rho = 0.439, p = 0.002; black: rho = 0.328,

p = 0.028; Hispanic: rho = 0.461, p = 0.001; Table 5).

Across all 48 states, abstinence education levels were signifi-

cantly correlated with the proportions of white and black teens in

the state populations (Table 4). In general, states with higher

proportions of white teens tended to emphasize abstinence less

(rho = 20.382, p = 0.007), and states with higher proportions of

black teens tended to emphasize abstinence more (rho = 0.419,

p = 0.003). When we included the proportion of white and black

teens in the state populations as covariates in a multivariate

analysis (evaluated at proportion white: 0.704 and proportion

black: 0.138), only the proportion of white teens had a significant

Table 3. Teen pregnancy, abortion and birth rates (per 1000 girls aged 14–19) by level of abstinence education.

Descriptive Statistics by Abstinence Education Level 95% Confidence Interval

Outcomes Level N Median Mean Std. Error Lower Bound Upper Bound Minimum Maximum

Teen Pregnancies 0 9 57.0 58.78 4.966 47.43 70.23 33 90

1 11 57.0 56.36 3.943 47.58 65.15 40 77

2 7 61.0 61.86 3.931 52.24 71.47 50 80

3 21 76.0 73.24 2.589 67.84 78.64 47 93

Total 48 62.5 65.00 2.064 60.85 69.15 33 93

Teen Abortions 0 9 11.0 15.78 2.681 9.6 21.96 9 28

1 11 16.0 20.27 3.069 13.43 27.11 10 41

2 7 15.0 13.57 2.010 8.65 18.49 6 20

3 21 12.0 14.86 1.306 12.13 17.58 6 27

Total 48 15.00 16.08 1.096 13.88 18.29 6 41

Teen Births 0 9 35.2 34.82 3.316 22.8 41.5 18 50

1 11 26.5 28.43 1.950 24.08 32.77 19 39

2 7 40.0 39.29 2.765 32.52 46.05 31 53

3 21 49.1 47.43 2.197 42.85 52.01 30 62

Total 48 38.5 39.52 1.687 36.13 42.92 18 62

Based on 2005 data for all states except North Dakota and Wyoming, N = number of states.
doi:10.1371/journal.pone.0024658.t003

Table 4. Socioeconomics and ethnic diversity as potential influences on teen pregnancy, abortion and birth rates in 48 states.

Correlation Coefficients Teen Rates per 1000 girls (14–19)

Adjusted median
household
income % Teens in population

1

Pregnancies Abortions Births White Black Hispanic

Abstinence Education level Spearman’s rho 0.507** 20.083 0.562** 20.349* 20.382** 0.419** 0.030

p (2-tailed) ,0.001 0.577 ,0.001 0.015 0.007 0.003 0.839

Teen Pregnancies per 1000 girls Spearman’s rho 0.329* 0.806** 20.383* 20.807** 0.597** 0.341*

p (2-tailed) 0.022 ,0.001 0.007 ,0.001 ,0.001 0.018

Teen Abortions per 1000 girls Spearman’s rho 20.221 20.116 20.564** 0.263 0.557**

p (2-tailed) 0.131 0.432 ,0.001 0.071 ,0.001

Teen Births per 1000 girls Spearman’s rho 20.296* 20.482** 0.393** 0.036

p (2-tailed) 0.041 0.001 0.006 0.806

Adjusted median income Spearman’s rho 0.298* 20.238 0.089

p (2-tailed) 0.040 0.103 0.547

% white teens in population Spearman’s rho 20.566** 20.532**

p (2-tailed) ,0.001 ,0.001

% black teens in population Spearman’s rho 20.014

p (2-tailed) 0.925

Significant correlations are marked in bold type (* significant at p,0.05, ** significant at p,0.01).
1
The % teen population variables are measures of the ethnic diversity of the states. Please note the teen pregnancy, abortion and birth data (per 1000) reflect the
behavior of all teens in each state: they are not limited to the behavior within that particular ethnic teen population (see Table 5).

doi:10.1371/journal.pone.0024658.t004

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effect on teen pregnancy (F = 42.206, p,0.001) and teen birth

rates (F = 5.894, p = 0.020). After accounting for this influence, the

level of abstinence education still had a significant effect on teen

pregnancy (F = 2.839, p = 0.049) and teen birth rates (N = 43

states: F = 7.782, p,0.001; Figure 3).

Medicaid waivers
If Medicaid waivers contribute to the positive correlation between

abstinence education and teen pregnancy at the state level, then

states with waivers should have different teen pregnancy and birth

rates than states without waivers. This was not the case. States with

waivers (N = 17) were represented across all four abstinence

education levels (Figure 4) and did not differ significantly in teen

pregnancy rates from states without waivers (N = 21, Mann

Whitney U = 237, p = 0.086), suggesting no significant effect of

waivers (at the state level) on the correlation between abstinence

levels and teen pregnancy rates. A recent study [14] found the same

level of (non-)significance (0.05,p,0.1) for the effect of waivers on

teen birth rates, but reported it as significant.

Discussion

This study used a correlational approach to assess whether

abstinence-only education is effective in reducing U.S. teen

pregnancy rates. Correlation can be due to causation, but it can

also be due to other underlying factors, which need to be examined.

Several factors besides abstinence education are correlated with

teen pregnancy rates. In agreement with previous studies, our

analysis showed that adjusted median household income and

proportion of white teens in the teen population both had a

significant influence on teen pregnancy rates. Richer states tend to

have a higher proportion of white teens in their teen populations,

tend to emphasize abstinence less, and tend to have lower teen

pregnancy and birth rates than poorer states. A recent study [25]

found that higher teen birth rates in poorer states were also

correlated with a higher

Sex education

Attitudes of Mothers toward Sex Education

DORIS B L O C H , RN, D R P H

Abstract: Data are presented on the attitudes of
mothers from the entire social class spectrum toward
content and timing of sex education for children (CT-
Attitudes), and also toward sex education in school (S-
Attitudes) in two California communities in 1969.
Findings underscore the necessity to consider these
two attitudinal variables separately. As a result of their
separation for study purposes, it was possible to arrive
at a four-fold typology or grouping of mothers: 1) CT

liberals in favor, and 2) CT liberals opposed to sex
education in schools, 3) CT conservatives in favor,
and 4) CT conservatives opposed to school programs
of sex education. It is inferred that educational plan-
ners need to pay due regard to the sentiments of all
four maternal groups and all social classes in devel-
oping sex education programs for families and for
school children. (Am J Public Health 69:911-915
1979.)

There is need for a better understanding of parental atti-
tudes about sex education in school. Previous studies have
suffered from a lack of precision in defining “attitudes
toward sex education.” Attitude measurement has generally
mixed two different components which should not be inter-
meshed or mistaken one for the other. These components
are: 1) attitudes toward the content and timing of sex educa-
tion (CT-Attitudes), and 2) attitudes toward sex education in
school (S-Attitudes).

The data reported in this paper are derived from a larger
study whose purpose was to examine the dilemma which
may occur when there is a gap between what mothers feel
they should do and what they are actually doing in the sex
education of their children.’- ̂

Methodology

The Sample

The study here presented was carried out in two Califor-
nia locations, a small industrial city and a suburban “bed-
room” community. A random sample of 194 names was
drawn from the roster of all seventh-grade girls enrolled in

Address reprint requests to Doris Bloch, RN, DrPH, Chief, Re-
search Support Section, Division of Nursing, Bureau of Health
Manpower, Health Resources Administration, Department of
Health, Education, and Welfare, Center Bldg., Room 3-50, 3700
East-West Highway, Hyattsville, MD 20782. This paper, submitted
to the Joumal August 9, 1978, was revised and accepted for pub-
lication April 18, 1979.

the respective school districts. Interviews were requested
with the mothers of all 194 girls. As 4.6 per cent of the
mothers could not be located, 5.1 per cent had insufficient
comprehension of English to participate in a satisfactory in-
terview, and 17.5 per cent declined to participate in the
study, interviews were conducted with 141 mothers (72.7 per
cent) of the original sample. Of these 141 interviews, 17 con-
stituted the basis for a pilot study. Consequently, the data
here reported reflect interviews with 124 mothers, whose in-
dex daughters (all seventh graders) ranged in age from 11 to
14.*

The socioeconomic status of the study families was esti-
mated by use of the Hollingshead two-factor index of social
position^ (Table 1). Most of the mothers were currently mar-
ried (87.1 per cent) and almost all (95.2 per cent) were be-
tween ages 30 and 49.

Variables and their Measurement

CT-Attitudes: For this research a number of scales for
the measurement of sex education attitudes were exam-
ined.*”* However, none of these existing tools were found
entirely applicable to the present study because they mixed
S- and CT-Attitudes and because many items were unsatis-
factorily worded.

A provisional Likert scale consisting of 25 items was
therefore constructed to measure mothers’ attitudes toward
content and timing of sex education (CT-Attitudes). Some of
the component items were newly formulated, others were

*23.4 per cent age 11,71 percentage 12, 5.6 per cent over age
12; 65.3 per cent had not yet passed menarche.

AJPH September 1979, Vol. 69, No. 9 911

BLOCH

TABLE 1-Distribution of Respondents by Ethnic Group and TABLE 2 – M e a n CT Attitude Scores, by Sociai Class

Social Class

l & l l
III
IV
V

Total

S>0(

No,

44
17
21)
10
91

ciai u i a s s

White

Percent

48.4
18.7

22.0
11.0

100

No.

0
0

9
10
19

Black

Per Cent

.0

.0
47.4
52.6

100

Spanish

No. Percent

0 .0
1 7.1

5 35.7
8 57.1

14 100

No.

44
18

34
28

124

Total

Per Cent

35.5
14.5
27.4
22.8

100

Soclal Class

l & l l
III
IV
V

Total

aF = 6.51; d.f.

N

44
18
34
28

124

= 3, 120; p < .001.

Mean^

15.36
14.00
12.64
11.57
13.56

SD

2.82
4.05
3.83
4.89
4.07

taken from existing scales. Approximately one-half were
worded to denote a liberal opinion and the other one-half a
conservative opinion toward sex education. Subsequently,
this collection of items was revised to encompass the final
10-item scale (Appendix 1).**

The possible range of scores for this 10-item scale is
from 0 (most conservative) to 20 (most liberal). The actual
range for the study sample was 0 to 20, with a mean of 13.56
and a standard deviation of 4.07. Testing by split-half relia-
bility revealed a correlation of 0.54, corrected to 0.70 by the
Spearman Brown formula.'”

S-Attitudes: A 25-item scale for measuring attitudes
toward sex education in school was likewise constructed and
subsequently revised into a 10-item scale (Appendix 2).**
Possible range of scores for this scale is 0 (most unfavorable)
to 20 (most favorable). Actual range of scores for the study
sample was 0 to 20, with a mean of 13.42 and a standard
deviation of 4.71. Split-half reliability was 0.83, corrected to
0.91 by the Spearman-Brown formula.

The mothers were also asked to choose from a list of sex
information sources those which should be considered as
first, second, and third in importance. As limited evidence of
validity, it should be noted that the mothers who named the
school as the most preferred choice had the highest mean S-
Attitude score of any of the study participants; and those
who did not name the school as a desirable choice at all had
the lowest mean scores of the entire sample. When tested by
one-way analysis of variance, the difference between the
means was found to be statistically significant (F = 5.18;
d.f. = 3, 120; p < .005).

Findings

As indicated, the study data were analyzed in relation to
socioeconomic status. They reveal that 83.9 per cent of the
mothers gave either the mother or both parents as the pre-
ferred source of sex information for children. Some 93.5 per
cent of the socioeconomic class (SEC) I-III mothers named
parents as the preferred source of sex information, com-
pared to 79.4 per cent of those in SEC IV and 67.8 percent of
the SEC V participants. This finding indicates that the higher
their socioeconomic status, the more likely are mothers to

**Additional information about scale development is available
in references 1 and 9.

regard parents as the preferred source of sex education for
children (Chi-square = 10.10; d.f. = 2; p < .01).

Within SECs IV and V, no significant relationship was
found between ethnic group (white, Spanish-sumamed, or
black) and preferred information source, although a some-
what larger proportion of the white mothers named “par-
ents” as the preferred sex educator.

Attitudes toward Content and Timing of Sex Education
(CT-Attitudes)

On a possible scale of 0 to 20, with 0 representing the
most conservative position and 20 the most liberal, the mean
CT-Attitude score of the total participating group was 13.56,
with a standard deviation of 4.07. The data show a significant
relationship between social class and CT-Attitudes. The
higher the social class of the mothers, the more likely are
they to hold liberal CT-Attitudes (Table 2).

Attitudes toward Sex Education in School (S-Attitudes)

On a possible scale of 0 to 20, the mean S-Attitude score
of the 124 mothers was 13.41, with a standard deviation of
4.70. As was also the case with CT-Attitudes, analysis of
variance indicated a significant relationship between S-Atti-
tudes and socioeconomic class. However, a comparison of
Table 2 and Table 3, which follows, shows that the CT-and
S-Attitude responses present quite different patterns.

While the mean CT-Attitude scores follow a striaght-
line pattern for the socioeconomic groups, with mothers in
Classes I-II most liberal and those in Class V most con-
servative, the pattern of mean S-Attitude scores for these
respective class groups is less clear. In the case of S-Atti-
tudes, t-tests for equality of means indicate a statistically sig-
nificant difference between the S-Attitudes of Classes I, II,
and III mothers (combined) and Class IV and V mothers
(combined) (t, 2-tailed, = 4.28; d.f. = 122; p < .001), with
mothers in the two lower socioeconomic classes holding the
most favorable attitudes toward sex education in school, and
those in the upper three SEC classes holding the least favor-
able attitudes.

Relationship between CT-Attitudes and S-Attitudes

As anticipated, the data reveal a significant positive as-
sociation between the two sex education attitude variables:
the more liberal the attitudes toward the content and timing
of sex education, the more favorable are the attitudes toward

912 AJPH September 1979, Vol. 69, No. 9

ATTITUDES TOWARD SEX EDUCATION

TABLE 3—Mean S-Attltude Scores, by Social Class TABLE 4 – M e a n S-Attitude Scores, by Attitudes toward Con-

Social Class

l & l l
III
IV
V

Total

N

44
18
34
28

124

Meana

12,18
10,61
15,23
14,96
13,41

SD

5 34
4,57
3,48
3,62
4,70

leni ai

CT-Attitudes”

Conservative
Moderate
Liberal

Total

na liming or s

N

38
57
29

124

«x Education

Meana

11,73
13,43
15,58
13.41

SO

4,88
4,64
3.75
4.70

= 6.64; d.f. = 3, 120; p < .001 ^F = 5.94; d.f. = 2, 121; p < .005,
”Conservative: score 0 – 1 1 ; moderate: score 12-16; liberal: score 17-20.

sex educatioti in school (Table 4), Iti additioti, however, they
support the belief that the two attitude componetits are
largely independent of each other (Figure 1). It is evident
that the correlation between the CT- and S-Attitudes is far
from perfect, Pearson product-moment correlation between
them is ,28, only 7.8 per cent of the variance between the
two distributions being shared. It was possible, therefore, to
delineate four diflFerent types of mothers in terms of their
varying attitudes toward content-timing, and school sex edu-
cation: 1) mothers with high scores on both components (HI-
HIs, N = 40); 2) those with low scores on both components
(LO-LOs, N = 41); 3) CT-liberals with relatively unfavor-
able S-Attitudes (HI-LOs, N = l8);and4)CT-conservatives
with relatively favorable S-Attitudes (LO-HIs, N = 25),

In an effort to discover which factors distinguish these
four groups of mothers, the four groups were compared on a
number of variables. All 18 CT-liberals with unfavorable S-
Attitudes belonged to Classes I, II, and III, and almost all
CT-conservatives with favorable S-Attitudes belonged to
Classes IV and V, A sizable majority of mothers in all
groups—but less so in the LO-HI group—preferred the home

20
19
18
17
16
15
14
13
12
11

10
9
8
7
6
5
4
3
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I I I I I I I I I I I I I I I I I
I 2 3 4 5 6 7 8 9 10 II 12 13 14 15 16 17 18 19 20
SCORE FOR ATTITUDES TOWARO CONTENT AND

TIMING OF SEX EDUCATION

FIGURE 1—Scattergram of Attitudes toward the Content and Timing
of Sex Education and Attitudes toward Sex Education in School
(N=124)

as the source of sex information. The LO-LO mothers were
most likely to refuse permission for a daughter interview***
(Table 5),

Discussion

Maternal attitudes toward sex information for children
were analyzed with a focus on attitudes toward the source of
such information, and attitudes toward the content and tim-
ing of sex information. Content and timing were combined
into one tool, because these elements appeared too closely
allied to permit separation. Data were derived from inter-
views with 124 mothers of the seventh grade girls.

The analyses have included the variable “social class,”
since other significant variables, such as religion and
mother’s sex knowledge, are themselves highly correlated
with SEC class. Other variables, such as mother’s own sex
education, did not seem to relate to attitudes. Data on a num-
ber of daughter variables, such as birth order and whether or
not the daughter had passed menarche, were collected, but
were not analyzed in relation to maternal attitudes.

As expected, the overwhelming majority of the mothers
in the sample (84 per cent) took the traditional view that par-
ents should be primarily responsible for the sex education of
their children. Witmer* reported in 1929 that over 90 per cent
of mothers expressed the belief that children should receive
sex information in the home. Although the two studies are
not strictly comparable, there seems to have been little
change in 40 years,

CT-Attitudes were conceptualized as relevant to the pa-
rental role. They are regarded as that part of the role which
prescribes what and when children should be taught about
sex. Consistent with certain prior studies, this investigator
found a positive association between CT-Attitudes and so-
cial class. From the study data it may be concluded that the
higher the social class of mothers, the more likely they are to
feel that parents should be the primary (but not necessarily
the sole) sex educators, and that children should be taught
the facts of life at an early age and in extensive degree. Con-
versely, the lower their social class, the more likely are they
to feel that sources other than parents should assume the sex

***The daughter interview was requested to gain information
about the extent and sources of the girls’ sex knowledge. These data
will be reported elsewhere.

AJPH September 1979, Vol. 69, No. 9 913

BLOCH

TABLE 5-Distribution of Respondents by Attitude Typoiogy, and by Sociai Ciass, Preferred
Source of Sex Information, and Completion of Daughter interviews

Social Class®
mill
IVV

Home Preferred Source”
Yes
No

Daughter Interview”^
Completed
Refused

No.

20
20

35
5

34
6

HI-HI

Per Cent

50.0
50.0

87.5
22.5

85.0
15.0

CT Attitude—S-Attitude Typology

No.

18
0

18
0

15
3

HI-LO

Per Cent

100.0
.0

100.0
.0

83.3
16.7

No.

3
22

16
g

22
3

LO-HI

Per Cent

12.0
88.0

64.0
36.0

88.0
12.0

No.

21
20

35
6

21
20

LO-LO

Per Cent

51.2
48.8

85.4
24.6

51.2
48.8

No.

62
62

104
20

92
32

Total

Per Cent

50.0
50.0

83.9
16.1

74.2
25.8

a) x2 = 32.46; df. = 3; p < .001
b) x’ = 11.33; df. = 3;p < .025
c) x* = 17.02; df. = 3;p < .001

education function, and that relatively little should be re-
vealed to children, and that little relatively late.

S-Attitudes were also conceptualized as relevant to the
parental role. In contrast to CT-Attitudes, the data do not
indicate a linear, positive association between social class
and attitudes toward sex education in school. Mothers in the
lower social strata were most favorably inclined toward hav-
ing sex education a school responsibility.

Previous opinion studies, using various methodologies,
have consistently found parents to be highly favorable
toward sex education in school.””” However, the need to
separate CT and S sex education attitude components has
not been recognized in the past, so that the peculiar correla-
tion between social class and S-Attitudes has gone unno-
ticed. Sex education experts have generally labored under
the belief that support for sex education in schools is highest
in the higher social classes.*’ “• ‘*

Intuitively it would be expected that mothers with liber-
al attitudes toward the content and timing of sex education
would also be favorably inclined toward sex education in
school. However, a sizable proportion of the sample did not
fit the expected pattem.

If these findings can be generalized, professionals plan-
ning parent sex education groups, and those planning school
sex education programs for children should consider four,
rather than two types of parents. That is to say, they have to
take into account not just parents who are for and parents
who are against sex education, but four types of parents who
may react differently to the type of program that is proposed
and/or offered.

The HI-HI group may be most likely to take advantage
of parent education programs, but not need it as much as the
other parents. If they themselves are not doing a good job of
sex education with their children—despite the fact that they
want to—they are happy to have the school fill in the gaps.

The LO-LO group may not be very interested in parent
or school sex education, presumably feeling that sex and

sex education are better “swept under the rug.” However,
an attempt to involve these mothers in facing the issues
may possibly result in relatively high payoff in terms of liber-
alized CT-Attitudes as well as in liberalized S-Attitudes.

The HI-LO group may or may not take advantage of
parent education. Other data from the study (not reported
here) tend to support the belief that these mothers feel that
they are already doing a good job, although the validity of
their self-assessment can be questioned. Their CT-Attitudes
are already liberal; if they are not doing a good job of sex
education themselves, this may be due to deeper psychologi-
cal factors on which parent education may have little if any
efiFect. They are unlikely to favor school programs in any
case.

The LO-HI group may well feel too insecure about
doing the job of sex education themselves to be interested in
taking advantage of any parent education program that might
be ofiFered. It may be that they and their children are most
benefited by a good school sex education program.

Professionals planning new or improved school family
life and sex education programs for children must consider
these four types of parents; to think only in terms of parents
who favor and those who oppose sex education would be an
inadequate explanation of reality, and could result in mis-
understanding both those parents who favor and those who
are opposed to sex education in schools.

REFERENCES
1. Bloch D: Attitudes and practices of mothers in the sex educa-

tion of their daughters. Unpublished doctoral dissertation. Uni-
versity of California, Berkeley, 1970.

2. Bloch D: Sex education practices of mothers. Joumal of Sex
Education and Therapy 4:7-12, 1978.

3. Hollingshead AB; Two factor index of social position. New
Haven; Author, 1957.

4. Harris MH; Parent-teacher attitudes toward sex education and
the film. Human Growth. Unpublished master’s thesis. Univer-
sity of Oregon, 1949.

914 AJPH September 1979, Vol. 69, No. 9

ATTITUDES TOWARD SEX EDUCATION

5. Lemon B: Parental attitudes toward sex education. Unpub-
lished master’s thesis. University of Oregon, 1948.

6. Reeve SB: Parental attitudes toward sex education in junior
high school. Unpublished master’s thesis, Florida State Univer-
sity, 1963.

7. Shaw ME and Wright JM: Scales for the measurement of atti-
tudes. New York: McGraw Hill, 1967, pp. 63-64.

8. Witmer HL: The attitudes of mothers toward sex education.
N.p.: The University of Minnesota Press, 1929.

9. Ward MJ and Lindeman CA: Instruments for Measuring Nurs-
ing Practice and Other Health Care Variables: Psychosocial and
Physiological, Volume 1 and 2. DHEW Pub. No. HRA 78-53
and 78-54, Division of Nursing, Bureau of Health Manpower,
Health Resources Administration, Washington, DC, 1979.

10. Fox DJ: Fundamentals of research in nursing. New York: Ap-
pleton-Century-Crofts, 1966, pp. 231-232.

11. Paddack CT: Public opinion of the people of Washington regard-
ing the teaching of sex education in the public schools. Unpub-
lished master’s thesis. The State College of Washington, 1951,
pp. 14-15.

12. Fink K: Public thinks sex education courses should be taught in
the schools. Journal of Social Hygiene 37:62-63, 1951.

13. Field MD: Poll favors high school sex courses. San Francisco
Chronicle, p. 14, August 29, 1969.

14. Gallup G: Sex revolution in U.S., Part II. Princeton, NJ: Ameri-
can Institute of Public Opinion, June 23, 1969. (Report of Opin-
ion Poll).

15. Libby RW: Parental attitudes toward high school sex education
programs. The Family Coordinator 19:234-247, 1970.

16. Bowers RS: A study of opinions concerning the teaching of sex
education in the public schools. Unpublished master’s thesis.
East Tennessee State College, p. 58, 1962.

ACKNOWLEDGti/IENTS
This investigation was supported through fellowship No. NU-

27,049 from the National Institutes of Health, Division of Nursing;
also (in part) through General Research Support Grant SOl-FR-
05441 from the National Institutes of Health to the School of Public
Health, University of Califomia, Berkeley, and (in part) through a
Graduate Student Grant-in-Aid from the Graduate Division of the
University of California, in Berkeley.

The writer wishes to express appreciation to Dr. Susan Gort-
ner. Dr. Eugene Levine, and Mr. Roger Libby for reading and com-
menting upon a draft of this paper. Special thanks go to Mrs. Evelyn
Lazzari for her extensive assistance with the most difficult task, the
condensing of a lengthy manuscript. This paper reports on a portion
of the author’s doctoral dissertation, completed at the University
of California, Berkeley, in 1970.

APPENDIX 1 —Revised CT-Attitude Scale APPENDIX 2—Revised S-Attitude Scale

A U D Children should not be told about intercourse
0 1 2 until they are at least 12 years old.

A U D If a child of 6 asks where babies come from,
0 1 2 heshouldbe told: “From God; He lets a little

seed grow under mother’s heart.”

A U D Children should be taught that playing with
0 1 2 themselves is a bad habit.

A U D Children should be told that women have to
0 1 2 be married to have babies.

A U D Children should be allowed to see their pets
2 1 0 mate.

A U D Parents should teach their children not to talk
0 1 2 about the facts of life with other children.

A U D If a young child asks how the baby got inside
0 1 2 the mother, it’s best to change the subject.

A U D Children should only be told about the facts
0 I 2 of life when they ask questions.

A U D A child who wants to know how babies get
2 I 0 out of the mother, should be told the truth, no

matter how young he is.

A U D When a 5-year-old asks how babies get out of
0 1 2 the mother, he should be told he is too young

to know.

A U D Teaching the facts of life in school is as im-
2 1 0 portant as teaching reading, writing, and

arithmetic.

A U D Children should learn about the facts of life as
2 1 0 part of their regular work in school.

A U D When the facts of life are taught in school,
0 1 2 children are given too much information

when they are too young.

A U D When children are given a good sex educa-
2 1 0 tion in school, they will make wiser decisions

when they grow up.

A U D The facts of life should be taught in school, so
2 1 0 that children get the proper information.

A U D Schools should take the lead in teaching the
2 1 0 facts of life.

A U D Boys and girls should be together in classes
2 1 0 where the facts of life are taught.

A U D Teachers are too overworked to teach sex
0 1 2 education in addition to all their other duties.

A U D If the facts of life are taught in school, chil-
2 1 0 dren leam that sex is a normal part of life.

A U D Classroom discussion about sex will stimu-
0 1 2 late too much interest in raw sex.

AJPH September 1979, Vol. 69, No. 9 915